=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902964612
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DESOTO HOME HEALTH CARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 08/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 CARLTON ST
-----------------------------------------------------
City | WAUCHULA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33873-3317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-773-9115
-----------------------------------------------------
Fax | 863-773-0749
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 CARLTON ST
-----------------------------------------------------
City | WAUCHULA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33873-3317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-773-9115
-----------------------------------------------------
Fax | 863-773-0749
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. DANIEL ASHLEY GRAHAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 863-773-9115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 351
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------