Provider Demographics
NPI:1710157656
Name:DPS HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:DPS HOME HEALTH AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:CLAUDE
Authorized Official - Last Name:DORVAL
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:561-337-4454
Mailing Address - Street 1:5725 CORPORATE WAY STE 201
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2038
Mailing Address - Country:US
Mailing Address - Phone:561-337-4454
Mailing Address - Fax:561-337-5027
Practice Address - Street 1:5725 CORPORATE WAY SUITE 201
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2856
Practice Address - Country:US
Practice Address - Phone:561-337-4454
Practice Address - Fax:561-337-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993038251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299993038OtherSTATE
FL000097200Medicaid
FLHHA299993038OtherAHCA -DPSHHA900
FLHHA299993038OtherAHCA -DPSHHA900
FL000097200Medicaid