Provider Demographics
NPI:1922037068
Name:VERSAILLES HOME HEALTH MEDICAL EQUIPTMENT
Entity Type:Organization
Organization Name:VERSAILLES HOME HEALTH MEDICAL EQUIPTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-896-7676
Mailing Address - Street 1:3850 CURRY FORD RD STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2708
Mailing Address - Country:US
Mailing Address - Phone:407-896-7676
Mailing Address - Fax:407-896-7177
Practice Address - Street 1:3850 CURRY FORD RD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2708
Practice Address - Country:US
Practice Address - Phone:407-896-7676
Practice Address - Fax:407-896-7177
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
FL13122661332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5376610001Medicare NSC