Provider Demographics
NPI:1689672065
Name:LEE MEMORIAL HOME HEALTH INC
Entity type:Organization
Organization Name:LEE MEMORIAL HOME HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SYSTEM DIRECTOR/ADMINISTRATOR HOME
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLANDAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:239-225-7688
Mailing Address - Street 1:12771 WESTLINKS DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8074
Mailing Address - Country:US
Mailing Address - Phone:239-225-7700
Mailing Address - Fax:239-225-7699
Practice Address - Street 1:12801 WESTLINKS DR STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8001
Practice Address - Country:US
Practice Address - Phone:239-225-7700
Practice Address - Fax:239-343-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA20643096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL083918300Medicaid
FL1013546OtherACM - PROVIDER NUMBER
FL107191Medicare ID - Type UnspecifiedPROVIDER NUMBER