Healthcare Provider Details

I. General information

NPI: 1427206481
Provider Name (Legal Business Name): 3D PROVIDERS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 SW WATERFORD CT SUITE 101
LAKE CITY FL
32025-0767
US

IV. Provider business mailing address

111 SW SABRE AVE
LAKE CITY FL
32024-0923
US

V. Phone/Fax

Practice location:
  • Phone: 386-752-0024
  • Fax:
Mailing address:
  • Phone: 386-755-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number1370
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DONNA DELBENE
Title or Position: PRESIDENT
Credential:
Phone: 386-752-0024