Healthcare Provider Details

I. General information

NPI: 1730118977
Provider Name (Legal Business Name): MEDSOUTH HOME HEALTH L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 J HARVEY ETHERIDGE ST
BONIFAY FL
32425-2106
US

IV. Provider business mailing address

201 J HARVEY ETHRIDGE ST
BONIFAY FL
32425-2106
US

V. Phone/Fax

Practice location:
  • Phone: 850-547-5549
  • Fax: 850-547-5458
Mailing address:
  • Phone: 850-547-5549
  • Fax: 850-547-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. DIANNE H. WHITE
Title or Position: MANAGING PARTNER
Credential:
Phone: 850-547-5549