Provider Demographics
NPI:1568239812
Name:COMPLETE HOME CARE - PRIVATE DUTY
Entity Type:Organization
Organization Name:COMPLETE HOME CARE - PRIVATE DUTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-877-0838
Mailing Address - Street 1:5601 EXECUTIVE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2508
Mailing Address - Country:US
Mailing Address - Phone:972-677-3471
Mailing Address - Fax:
Practice Address - Street 1:1925 S PERIMETER RD STE 124
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-7122
Practice Address - Country:US
Practice Address - Phone:954-686-5773
Practice Address - Fax:954-686-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health