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General NPI Number Information
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NPI Number | 1114675345
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Entity Type | Organization
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Legal Business Name | SALEM AGENCY LLC
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 05/07/2022
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Provider Practice Location Address
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Address Line | 4451 OLD WINTER GARDEN RD
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City | ORLANDO
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State | FL
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Zip | 32811-4244
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Country | US
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Telephone | 407-867-9822
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Fax |
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Provider Business Mailing Address
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Address Line | 1424 CENTER ST
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City | OCOEE
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State | FL
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Zip | 34761-4019
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Country | US
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Telephone | 407-867-9822
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Fax |
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Authorized Official
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Title or Position | OWNER/MGR
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Name | PIERRE S DORMEVIL
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Credential |
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Telephone | 407-867-9822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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