Provider Demographics
NPI:1700938206
Name:DIRECT CARE HOME HEALTH, INC.
Entity Type:Organization
Organization Name:DIRECT CARE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WUNDERLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-337-9940
Mailing Address - Street 1:1361 ROYAL PALM SQUARE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-1009
Mailing Address - Country:US
Mailing Address - Phone:239-337-9940
Mailing Address - Fax:239-337-9941
Practice Address - Street 1:1361 ROYAL PALM SQUARE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-1009
Practice Address - Country:US
Practice Address - Phone:239-337-9940
Practice Address - Fax:239-337-9941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992622251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299992622OtherSTATE LICENSE