Healthcare Provider Details

I. General information

NPI: 1952728362
Provider Name (Legal Business Name): P & D COMPANION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 DELANEY DR #1223
TALLAHASSEE FL
32309-3418
US

IV. Provider business mailing address

1555 DELANEY DR #1223
TALLAHASSEE FL
32309-3418
US

V. Phone/Fax

Practice location:
  • Phone: 850-405-0545
  • Fax:
Mailing address:
  • Phone: 850-405-0545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number229723
License Number StateFL

VIII. Authorized Official

Name: MS. DEWANDA L SMITH
Title or Position: MANAGER
Credential: AA
Phone: 850-405-0545