Provider Demographics
NPI: | 1407995657 |
---|---|
Name: | MEDICOR HOMECARE INC |
Entity type: | Organization |
Organization Name: | MEDICOR HOMECARE INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MANUEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DELGADO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 800-250-4468 |
Mailing Address - Street 1: | PO BOX 850001 |
Mailing Address - Street 2: | |
Mailing Address - City: | ORLANDO |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32885-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-250-4468 |
Mailing Address - Fax: | 866-930-8001 |
Practice Address - Street 1: | 1076 NW 53RD ST |
Practice Address - Street 2: | |
Practice Address - City: | FORT LAUDERDALE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33309-3146 |
Practice Address - Country: | US |
Practice Address - Phone: | 800-250-4468 |
Practice Address - Fax: | 866-930-8001 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-02-05 |
Last Update Date: | 2012-03-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | 1313213 | 332BX2000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332BX2000X | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |