MEDICARE: DP HOME HEALTH CARE ASSOCIATES INC

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	332B00000X	Durable Medical Equipment & Medical Supplies	118	AL

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
2	51054625	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1609919265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DP HOME HEALTH CARE ASSOCIATES INC

Provider Business Mailing Address
First Line	:	PO BOX 1342
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36633-1342
Country	:	US
Telephone Number	:	251-471-2113
Fax Number	:	251-476-1672

Provider Business Practice Location Address
First Line	:	2168 A ST. STEPHENS ROAD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36617-3732
Country	:	US
Telephone Number	:	251-471-2113
Fax Number	:	251-476-1672

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DONALD L. PONQUINETTE
Credential	:	PD, CDM
Telephone Number	:	251-471-2113

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	05/22/2013

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