Provider Demographics
NPI:1750981239
Name:247 HEALTHCARE AGENCY
Entity type:Organization
Organization Name:247 HEALTHCARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHURIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-779-1613
Mailing Address - Street 1:5050 S US HIGHWAY 17/92 STE 106
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3863
Mailing Address - Country:US
Mailing Address - Phone:321-800-4488
Mailing Address - Fax:321-800-4499
Practice Address - Street 1:5050 S US HIGHWAY 17/92 STE 106
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-3863
Practice Address - Country:US
Practice Address - Phone:321-800-4488
Practice Address - Fax:321-800-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies