Provider Demographics
NPI:1508635418
Name:B & DIAZ ENTERPRISES LLC
Entity Type:Organization
Organization Name:B & DIAZ ENTERPRISES LLC
Other - Org Name:FIRSTLIGHT HOMECARE OF LAKELAND, FL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GASPAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-562-1025
Mailing Address - Street 1:6700 S FLORIDA AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3311
Mailing Address - Country:US
Mailing Address - Phone:863-606-1933
Mailing Address - Fax:
Practice Address - Street 1:6700 S FLORIDA AVE STE 14
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3311
Practice Address - Country:US
Practice Address - Phone:954-562-1025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B & DIAZ ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care