Provider Demographics
NPI:1972681724
Name:AMERICAN HOME THERAPY PROVIDER, INC.
Entity Type:Organization
Organization Name:AMERICAN HOME THERAPY PROVIDER, INC.
Other - Org Name:AMERICAN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENANO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:941-505-4663
Mailing Address - Street 1:2421 SHREVE ST STE 113
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5972
Mailing Address - Country:US
Mailing Address - Phone:941-505-4663
Mailing Address - Fax:941-575-4445
Practice Address - Street 1:2421 SHREVE ST STE 113
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5972
Practice Address - Country:US
Practice Address - Phone:941-505-4663
Practice Address - Fax:941-575-4445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HOME THERAPY PROVIDER,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991531251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107737OtherMEDICARE 107737
FLJW4OtherBCBS FL
FL107737OtherMEDICARE 107737