Provider Demographics
NPI:1609507110
Name:DYNAMIC HOUSECALLS
Entity Type:Organization
Organization Name:DYNAMIC HOUSECALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MBAM
Authorized Official - Suffix:
Authorized Official - Credentials:AGNP-C
Authorized Official - Phone:347-316-7396
Mailing Address - Street 1:30218 CASCADING BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKSHIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77423-2786
Mailing Address - Country:US
Mailing Address - Phone:347-316-7396
Mailing Address - Fax:
Practice Address - Street 1:30218 CASCADING BROOK WAY
Practice Address - Street 2:
Practice Address - City:BROOKSHIRE
Practice Address - State:TX
Practice Address - Zip Code:77423-2786
Practice Address - Country:US
Practice Address - Phone:347-316-7396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No273Y00000XHospital UnitsRehabilitation Unit
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherHOUSECALLS