Provider Demographics
NPI:1730770694
Name:DYNAMIKS HOME CARE INC
Entity type:Organization
Organization Name:DYNAMIKS HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FELVINA
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:RENNA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-632-0926
Mailing Address - Street 1:1861 N CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5955
Mailing Address - Country:US
Mailing Address - Phone:407-984-9379
Mailing Address - Fax:
Practice Address - Street 1:15050 ELDERBERRY LN STE 6-12
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8504
Practice Address - Country:US
Practice Address - Phone:941-681-1086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104409300Medicaid