Provider Demographics
NPI:1568773869
Name:PATRIOT HOME HEALTH NURSING LLC
Entity Type:Organization
Organization Name:PATRIOT HOME HEALTH NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LEDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-326-0897
Mailing Address - Street 1:1814 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-3642
Mailing Address - Country:US
Mailing Address - Phone:813-600-5961
Mailing Address - Fax:
Practice Address - Street 1:1814 N 15TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-3642
Practice Address - Country:US
Practice Address - Phone:813-600-5961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109743Medicare Oscar/Certification