Healthcare Provider Details

I. General information

NPI: 1689430753
Provider Name (Legal Business Name): DELL HOUSE OF HOPE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 ORANGE AVE
DAYTONA BEACH FL
32114-4310
US

IV. Provider business mailing address

128 ORANGE AVE
DAYTONA BEACH FL
32114-4310
US

V. Phone/Fax

Practice location:
  • Phone: 689-254-9120
  • Fax:
Mailing address:
  • Phone: 407-259-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RAVEN JOHNSON
Title or Position: MANAGER
Credential:
Phone: 321-946-4900