Provider Demographics
NPI:1467862276
Name:DORCAS HOUSE
Entity Type:Organization
Organization Name:DORCAS HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:941-720-2803
Mailing Address - Street 1:2601 13TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-4030
Mailing Address - Country:US
Mailing Address - Phone:941-720-2803
Mailing Address - Fax:
Practice Address - Street 1:2601 13TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4030
Practice Address - Country:US
Practice Address - Phone:941-749-0780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8933310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility