MEDICARE: DOLL BABYS HOME CARE 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	261QD1600X	Developmental Disabilities Clinic/Center

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	:	1619574605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOLL BABYS HOME CARE INC

Provider Business Mailing Address
First Line	:	7005 PASO ROBLES BLVD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-1223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7005 PASO ROBLES BLVD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-1223
Country	:	US
Telephone Number	:	772-216-6810
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RAKEVAH WILSON
Credential	:
Telephone Number	:	772-216-6810

Provider Enumeration Date	:	10/03/2020
Last Update Date	:	10/03/2020

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