Healthcare Provider Details

I. General information

NPI: 1073892782
Provider Name (Legal Business Name): DESOTO HOME HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 US 27 S
SEBRING FL
33870-5512
US

IV. Provider business mailing address

3975 US 27 S
SEBRING FL
33870-5512
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-2606
  • Fax: 863-382-3969
Mailing address:
  • Phone: 863-382-2606
  • Fax: 863-382-3969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1313719
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number32-6855
License Number StateFL

VIII. Authorized Official

Name: MR. DANIEL ASHLEY GRAHAM
Title or Position: CEO
Credential:
Phone: 863-382-2606