Provider Demographics
NPI:1427206481
Name:3D PROVIDERS CORPORATION
Entity Type:Organization
Organization Name:3D PROVIDERS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELBENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-752-0024
Mailing Address - Street 1:111 SW SABRE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-0923
Mailing Address - Country:US
Mailing Address - Phone:386-755-3465
Mailing Address - Fax:
Practice Address - Street 1:144 SW WATERFORD CT
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-0767
Practice Address - Country:US
Practice Address - Phone:386-752-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 372600000X, 3747P1801X, 385H00000X, 385HR2065X
FL1370251J00000X
FL376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, ChildGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679482396OtherMEDICAID-WAIVER
FL1370OtherHEALTH CARE SERVICES POOL
FL232905OtherHOMEMAKER & COMPANION /AHCA
FL679482301OtherELDER OPTIONS
FL679482398OtherFLORIDA SUPPORTED LIVING WAIVER