Provider Demographics
NPI:1750052882
Name:DUDLEY COMMUNITY CARE
Entity Type:Organization
Organization Name:DUDLEY COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-628-8387
Mailing Address - Street 1:3058 HIGHWAY 162
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLTON
Mailing Address - State:FL
Mailing Address - Zip Code:32426-7236
Mailing Address - Country:US
Mailing Address - Phone:850-628-8387
Mailing Address - Fax:
Practice Address - Street 1:3058 HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:CAMPBELLTON
Practice Address - State:FL
Practice Address - Zip Code:32426-7236
Practice Address - Country:US
Practice Address - Phone:850-628-8387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health