Provider Demographics
NPI:1417559733
Name:BALM OF GILEAD HOME HEALTH
Entity Type:Organization
Organization Name:BALM OF GILEAD HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUBODE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLATUNJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-428-4300
Mailing Address - Street 1:6611 US HIGHWAY 19 STE 207
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-1732
Mailing Address - Country:US
Mailing Address - Phone:813-428-4300
Mailing Address - Fax:
Practice Address - Street 1:505 AVENUE A NW # W
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4650
Practice Address - Country:US
Practice Address - Phone:813-428-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health