Provider Demographics
NPI:1871193334
Name:ALL EXECUTIVE HEALTHCARE AGENCY LLC
Entity Type:Organization
Organization Name:ALL EXECUTIVE HEALTHCARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DR. LATARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-528-6020
Mailing Address - Street 1:7316 BARBERIE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-4105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:841 PRUDENTIAL DR STE 1211
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8329
Practice Address - Country:US
Practice Address - Phone:904-528-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health