Healthcare Provider Details

I. General information

NPI: 1891171815
Provider Name (Legal Business Name): MEDICOR HOMECARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3429 N LIBERTY ST
JACKSONVILLE FL
32206-2221
US

IV. Provider business mailing address

3429 N LIBERTY ST
JACKSONVILLE FL
32206-2221
US

V. Phone/Fax

Practice location:
  • Phone: 904-619-2433
  • Fax: 904-619-2541
Mailing address:
  • Phone: 904-619-2433
  • Fax: 904-619-2541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MANUEL DELGADO JR.
Title or Position: PRESIDENT
Credential:
Phone: 813-930-8000