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General NPI Number Information
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NPI Number | 1790464758
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Entity Type | Organization
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Legal Business Name | HOMECARE HUB OF NORTHEAST FLORIDA, LLC
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 128 ORANGE AVE STE 233
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4310
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Country | US
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Telephone | 386-271-3662
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Fax |
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Provider Business Mailing Address
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Address Line | 8400 E PRENTICE AVE PH 1500
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2927
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Country | US
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Telephone | 616-581-7878
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL DEAK
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Credential |
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Telephone | 616-581-7878
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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 |
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