Organization
DESOTO HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAUN GRUBB (PRESIDENT)
(386) 752-1699
Entity
Organization
Contact information
Practice address
311 N MARION AVE, LAKE CITY, FL 32055-2866
(386) 752-1699
(386) 752-6000
Mailing address
311 N MARION AVE, LAKE CITY, FL 32055-2866
(386) 752-1699
(386) 752-6000
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
1919
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R9451
BCBS PROVIDER NUMBER
FL
Enumeration date
05/31/2005
Last updated
08/22/2020
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