=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790309375
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEAK-N-HALL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2020
-----------------------------------------------------
Last Update Date | 03/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1950 LAUREL MANOR DR STE 135
-----------------------------------------------------
City | THE VILLAGES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32162-5602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-720-6277
-----------------------------------------------------
Fax | 843-651-1592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2520 S HIGHWAY 17
-----------------------------------------------------
City | MURRELLS INLET
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29576-7657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-651-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | JAMIE LEE RECUPERO
-----------------------------------------------------
Credential | COO
-----------------------------------------------------
Telephone | 843-651-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------