Provider Demographics
NPI:1629344601
Name:DYNAMIC HEALTHCARE LLC
Entity Type:Organization
Organization Name:DYNAMIC HEALTHCARE LLC
Other - Org Name:DYNAMIC HEALTHCARE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARZIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:ASA/BA
Authorized Official - Phone:707-832-4277
Mailing Address - Street 1:408 7TH ST STE D-2
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-6805
Mailing Address - Country:US
Mailing Address - Phone:707-832-4277
Mailing Address - Fax:707-832-4176
Practice Address - Street 1:408 7TH ST STE D-2
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-6805
Practice Address - Country:US
Practice Address - Phone:707-832-4277
Practice Address - Fax:707-832-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
251E00000XOtherMEDICARE NPI