Provider Demographics
NPI:1861077513
Name:PRIVATE DUTY HOMECARE GROUP LLP
Entity type:Organization
Organization Name:PRIVATE DUTY HOMECARE GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-733-1219
Mailing Address - Street 1:PO BOX 21463
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-1463
Mailing Address - Country:US
Mailing Address - Phone:305-733-1219
Mailing Address - Fax:661-412-8288
Practice Address - Street 1:11101 TORBAY DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-2921
Practice Address - Country:US
Practice Address - Phone:305-733-1219
Practice Address - Fax:661-412-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health