Provider Demographics
NPI:1194267906
Name:OTINDA AND ASSOCIATES HOMECARES
Entity type:Organization
Organization Name:OTINDA AND ASSOCIATES HOMECARES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OTINDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-860-2454
Mailing Address - Street 1:455 S NULTON AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-3767
Mailing Address - Country:US
Mailing Address - Phone:484-860-2454
Mailing Address - Fax:
Practice Address - Street 1:455 S NULTON AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-3767
Practice Address - Country:US
Practice Address - Phone:484-860-2454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251V00000XAgenciesVoluntary or Charitable
No305R00000XManaged Care OrganizationsPreferred Provider Organization