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General NPI Number Information
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NPI Number | 1629344601
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Entity Type | Organization
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Legal Business Name | DYNAMIC HEALTHCARE LLC
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Dates
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Enumeration Date | 03/23/2012
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 408 7TH ST STE D-2
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City | EUREKA
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State | CA
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Zip | 95501-6805
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Country | US
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Telephone | 707-832-4277
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Fax | 707-832-4176
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Provider Business Mailing Address
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Address Line | 408 7TH ST STE D-2
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City | EUREKA
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State | CA
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Zip | 95501-6805
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Country | US
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Telephone | 707-832-4277
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Fax | 707-832-4176
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | MR. LARZIE R JOHNSON
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Credential | ASA/BA
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Telephone | 707-832-4277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | CA
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