1558684910 NPI number — SUNCREST HOME HEALTH OF CENTRAL FL, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558684910 NPI number — SUNCREST HOME HEALTH OF CENTRAL FL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNCREST HOME HEALTH OF CENTRAL FL, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1558684910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37115-5033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-627-9267
Provider Business Mailing Address Fax Number:
615-577-0081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
994 DOUGLAS AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ALTAMONTE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32714-2068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-328-9993
Provider Business Practice Location Address Fax Number:
407-328-8227
Provider Enumeration Date:
03/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MCFADDIN
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF LICENSING/ACCREDITATION
Authorized Official Telephone Number:
615-712-2250

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  299992128 , 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)

  • Identifier: 004232000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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