Provider Demographics
NPI:1730247537
Name:DESOTO HOME HEALTH CARE INC.
Entity type:Organization
Organization Name:DESOTO HOME HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-494-4755
Mailing Address - Street 1:301 N. BREVARD AVE.
Mailing Address - Street 2:SUTIE C
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266
Mailing Address - Country:US
Mailing Address - Phone:863-494-4755
Mailing Address - Fax:863-494-9276
Practice Address - Street 1:301 N. BREVARD AVE.
Practice Address - Street 2:SUTIE C
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266
Practice Address - Country:US
Practice Address - Phone:863-494-4755
Practice Address - Fax:863-494-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL349332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0408570002Medicare NSC