Provider Demographics
NPI:1356117659
Name:BRANDON HOME CARE LLC
Entity type:Organization
Organization Name:BRANDON HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-682-1775
Mailing Address - Street 1:18647 LAKE LOLA RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523
Mailing Address - Country:US
Mailing Address - Phone:813-682-1775
Mailing Address - Fax:813-343-3804
Practice Address - Street 1:1755 S KINGS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-684-1972
Practice Address - Fax:813-343-3804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRANDON HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299992190OtherAHCA