Provider Demographics
NPI:1659702348
Name:MY OTHER DAUGHTER
Entity Type:Organization
Organization Name:MY OTHER DAUGHTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-400-3401
Mailing Address - Street 1:312 E VENICE AVE STE 119
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4670
Mailing Address - Country:US
Mailing Address - Phone:941-400-3401
Mailing Address - Fax:941-296-6842
Practice Address - Street 1:312 E VENICE AVE STE 119
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4670
Practice Address - Country:US
Practice Address - Phone:941-400-3401
Practice Address - Fax:941-296-6842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care