Healthcare Provider Details

I. General information

NPI: 1619767845
Provider Name (Legal Business Name): PLATINUM HOME & COMMUNITY MOBILITY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 S 8TH ST UNIT E
FERNANDINA BEACH FL
32034-3706
US

IV. Provider business mailing address

15400 PEARL RD STE 207
STRONGSVILLE OH
44136-6051
US

V. Phone/Fax

Practice location:
  • Phone: 904-261-2111
  • Fax: 904-261-1163
Mailing address:
  • Phone: 440-557-6307
  • Fax: 440-557-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MARC ANTHONY VASIL
Title or Position: PRESIDENT
Credential: MPT
Phone: 440-229-5822