1457553273 NPI number — FIRST HEALTH RESOURCES CORPORATION

Table of content: (NPI 1457553273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457553273 NPI number — FIRST HEALTH RESOURCES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST HEALTH RESOURCES CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY HOME CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457553273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1133 BAL HARBOR BLVD UNIT 1139 PMB 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUNTA GORDA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33950-6574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-983-3700
Provider Business Mailing Address Fax Number:
863-983-9883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 W SUGARLAND HWY STE E-8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEWISTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33440-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-983-3700
Provider Business Practice Location Address Fax Number:
863-983-9883
Provider Enumeration Date:
06/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PENANO
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
863-983-3700

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)