Provider Demographics
NPI:1083039937
Name:DYNAMIKS HEALTH CARE. LLC
Entity type:Organization
Organization Name:DYNAMIKS HEALTH CARE. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-289-7078
Mailing Address - Street 1:6638 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1331
Mailing Address - Country:US
Mailing Address - Phone:727-289-7078
Mailing Address - Fax:888-350-0447
Practice Address - Street 1:6638 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1331
Practice Address - Country:US
Practice Address - Phone:727-289-7078
Practice Address - Fax:888-350-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-02
Last Update Date:2014-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25100000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health