Provider Demographics
NPI:1013533108
Name:DERBY HOME CARE LLC
Entity Type:Organization
Organization Name:DERBY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DERBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-440-2869
Mailing Address - Street 1:1657 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-1546
Mailing Address - Country:US
Mailing Address - Phone:574-440-2869
Mailing Address - Fax:
Practice Address - Street 1:1657 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-1546
Practice Address - Country:US
Practice Address - Phone:574-440-2869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care