Provider Demographics
NPI:1801135413
Name:PRIVATE DUTY HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:PRIVATE DUTY HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTANZA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:269-983-0300
Mailing Address - Street 1:2626 NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1938
Mailing Address - Country:US
Mailing Address - Phone:269-983-0300
Mailing Address - Fax:269-983-0303
Practice Address - Street 1:2626 NILES AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1938
Practice Address - Country:US
Practice Address - Phone:269-983-0300
Practice Address - Fax:269-983-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health