Provider Demographics
NPI:1811528003
Name:360 HOME HEALTH CARE AGENCY, INC
Entity type:Organization
Organization Name:360 HOME HEALTH CARE AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DR. RUDOLPH
Authorized Official - Middle Name:MICKEY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT, CBC, RN
Authorized Official - Phone:392-333-1310
Mailing Address - Street 1:PO BOX 1199
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33970-1199
Mailing Address - Country:US
Mailing Address - Phone:239-694-9102
Mailing Address - Fax:239-694-9101
Practice Address - Street 1:3611 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1304
Practice Address - Country:US
Practice Address - Phone:239-333-1310
Practice Address - Fax:239-900-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health