Provider Demographics
NPI:1134384076
Name:DYNAFLEX HOME HEALTH CARE, LLC
Entity type:Organization
Organization Name:DYNAFLEX HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BAUTISTA
Authorized Official - Last Name:MABANGLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:586-977-3660
Mailing Address - Street 1:4147 METRO PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4520
Mailing Address - Country:US
Mailing Address - Phone:586-977-3660
Mailing Address - Fax:586-977-3679
Practice Address - Street 1:4147 METRO PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4520
Practice Address - Country:US
Practice Address - Phone:586-977-3660
Practice Address - Fax:586-977-3679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health