Provider Demographics
NPI:1730118977
Name:MEDSOUTH HOME HEALTH L.L.C.
Entity Type:Organization
Organization Name:MEDSOUTH HOME HEALTH L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-547-5549
Mailing Address - Street 1:201 J HARVEY ETHRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-2106
Mailing Address - Country:US
Mailing Address - Phone:850-547-5549
Mailing Address - Fax:850-547-5458
Practice Address - Street 1:201 J HARVEY ETHERIDGE ST
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-2106
Practice Address - Country:US
Practice Address - Phone:850-547-5549
Practice Address - Fax:850-547-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
10-7765Medicare ID - Type Unspecified