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General NPI Number Information
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NPI Number | 1417559733
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Entity Type | Organization
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Legal Business Name | BALM OF GILEAD HOME HEALTH
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 505 AVENUE A NW # W
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4650
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Country | US
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Telephone | 813-428-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 6611 US HIGHWAY 19 STE 207
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-1732
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Country | US
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Telephone | 813-428-4300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. OLUBODE OLATUNJI
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Credential |
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Telephone | 813-428-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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