Provider Demographics
NPI:1477576353
Name:DIABETES HOME CARE, INC.
Entity Type:Organization
Organization Name:DIABETES HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/GENERAL MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:BUCHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-698-4626
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-0265
Mailing Address - Country:US
Mailing Address - Phone:386-698-4626
Mailing Address - Fax:386-698-4631
Practice Address - Street 1:508 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-2504
Practice Address - Country:US
Practice Address - Phone:386-698-4626
Practice Address - Fax:386-698-4631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0538430001Medicare ID - Type Unspecified