Provider Demographics
NPI:1508248543
Name:MEDICOR HOMECARE, INC
Entity Type:Organization
Organization Name:MEDICOR HOMECARE, INC
Other - Org Name:MEDICOR HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:813-930-8000
Mailing Address - Street 1:3429 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-2221
Mailing Address - Country:US
Mailing Address - Phone:904-619-2433
Mailing Address - Fax:904-619-2541
Practice Address - Street 1:3403 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2713
Practice Address - Country:US
Practice Address - Phone:813-930-8000
Practice Address - Fax:813-930-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies