Healthcare Provider Details

I. General information

NPI: 1083499495
Provider Name (Legal Business Name): DHH CONNECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 MARILYN LN
NORTH PORT FL
34286-7689
US

IV. Provider business mailing address

1232 MARILYN LN
NORTH PORT FL
34286-7689
US

V. Phone/Fax

Practice location:
  • Phone: 305-501-0630
  • Fax:
Mailing address:
  • Phone: 305-501-0630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAILIE DUBOIS
Title or Position: CO-OWNER
Credential: MSDE
Phone: 248-564-8453