Provider Demographics
NPI:1538406277
Name:MS SUPPLY & HOME HEALTH CO.
Entity type:Organization
Organization Name:MS SUPPLY & HOME HEALTH CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-680-3722
Mailing Address - Street 1:PO BOX 2642
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-2642
Mailing Address - Country:US
Mailing Address - Phone:800-680-3722
Mailing Address - Fax:800-680-2899
Practice Address - Street 1:1315 HOMESTEAD RD N
Practice Address - Street 2:UNIT G
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6034
Practice Address - Country:US
Practice Address - Phone:800-680-3722
Practice Address - Fax:800-680-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994094251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032330600Medicaid
FL032330600Medicaid
FL109683Medicare Oscar/Certification