Provider Demographics
NPI:1871841965
Name:NORTHWEST FLORIDA HOME CARE, INC.
Entity Type:Organization
Organization Name:NORTHWEST FLORIDA HOME CARE, INC.
Other - Org Name:SYNERGY HOME CARE OF NW FL, IN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARCHIE
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:DALBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-687-3965
Mailing Address - Street 1:141 MACK BAYOU LOOP STE 303
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-7194
Mailing Address - Country:US
Mailing Address - Phone:850-687-3965
Mailing Address - Fax:
Practice Address - Street 1:141 MACK BAYOU LOOP STE 303
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-7194
Practice Address - Country:US
Practice Address - Phone:850-687-3965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994036253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care