Provider Demographics
NPI:1700312063
Name:IMMACULEE HOME CARE LLC
Entity Type:Organization
Organization Name:IMMACULEE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMMACULEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-496-4316
Mailing Address - Street 1:5758 OAK HILL MANOR DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-3750
Mailing Address - Country:US
Mailing Address - Phone:407-496-4316
Mailing Address - Fax:407-203-8336
Practice Address - Street 1:5758 OAK HILL MANOR DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-3750
Practice Address - Country:US
Practice Address - Phone:407-496-4316
Practice Address - Fax:407-203-8336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12912310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility