=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689063596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ON TIME HOME HEALTH CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2015
-----------------------------------------------------
Last Update Date | 01/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3507 LEE BLVD STE 276
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33971-1318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-674-9015
-----------------------------------------------------
Fax | 239-674-7944
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3507 LEE BLVD STE 276
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33971-1318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-674-9015
-----------------------------------------------------
Fax | 239-674-7944
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. CARL DE NOBREGA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-674-9015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299994330
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------