Provider Demographics
NPI:1740848209
Name:DOVINITI-J15 12 INC
Entity type:Organization
Organization Name:DOVINITI-J15 12 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-645-2945
Mailing Address - Street 1:13798 NW 4TH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6227
Mailing Address - Country:US
Mailing Address - Phone:954-645-2945
Mailing Address - Fax:954-530-1039
Practice Address - Street 1:2701 EXECUTIVE PARK DR STE 3
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3632
Practice Address - Country:US
Practice Address - Phone:954-645-2945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112065800Medicaid