=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306076153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DYNAMIC HEALTHCARE SOLUTIONS, INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2009
-----------------------------------------------------
Last Update Date | 07/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1126 MIDDLESEX ST SUITE # 7
-----------------------------------------------------
City | LOWELL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01851-1352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-674-8010
-----------------------------------------------------
Fax | 978-674-8010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1126 MIDDLESEX ST SUITE # 7
-----------------------------------------------------
City | LOWELL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01851-1352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-674-8010
-----------------------------------------------------
Fax | 978-674-8010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MR. CHRISTOPHER OCHIJEH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-674-8010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | R2815
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------