Provider Demographics
NPI:1982374948
Name:DOMINION RESOURCE CENTER LLC
Entity Type:Organization
Organization Name:DOMINION RESOURCE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:FOLAKE
Authorized Official - Middle Name:OLUYEMISI
Authorized Official - Last Name:BAMIGBADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-474-8516
Mailing Address - Street 1:6700 S FLORIDA AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3310
Mailing Address - Country:US
Mailing Address - Phone:813-474-8516
Mailing Address - Fax:
Practice Address - Street 1:6700 S FLORIDA AVE STE 9
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3310
Practice Address - Country:US
Practice Address - Phone:863-940-2910
Practice Address - Fax:863-940-2979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health