MEDICARE: M.D. HOME HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	299992400	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235179607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.D. HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	580 VILLAGE BLVD STE 315
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1953
Country	:	US
Telephone Number	:	561-689-0445
Fax Number	:	561-689-0415

Provider Business Practice Location Address
First Line	:	580 VILLAGE BLVD STE 315
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1953
Country	:	US
Telephone Number	:	561-689-0445
Fax Number	:	561-689-0415

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MARIO DARNELL DICKERSON
Credential	:	RN, RRT
Telephone Number	:	561-689-0445

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	11/03/2022

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