Provider Demographics
NPI:1740001007
Name:DYNAMIC HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:DYNAMIC HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:ODETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-319-3489
Mailing Address - Street 1:84 RED CEDAR WAY
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-4538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:84 RED CEDAR WAY
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-4538
Practice Address - Country:US
Practice Address - Phone:240-614-5324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health