Healthcare Provider Details

I. General information

NPI: 1669118261
Provider Name (Legal Business Name): DYP AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2022
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 OLD WINTER GARDEN RD
ORLANDO FL
32811-4244
US

IV. Provider business mailing address

4451 OLD WINTER GARDEN RD
ORLANDO FL
32811-4244
US

V. Phone/Fax

Practice location:
  • Phone: 407-867-9822
  • Fax: 407-237-9767
Mailing address:
  • Phone: 407-867-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: PIERRE S DORMEVIL
Title or Position: OWNER NURSING ASSISTANT
Credential:
Phone: 407-867-9822