1831131200 NPI number — FLORIDA HOSPITAL WATERMAN INC

Table of content: (NPI 1831131200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831131200 NPI number — FLORIDA HOSPITAL WATERMAN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA HOSPITAL WATERMAN INC
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:
FLORIDA HOSPITAL WATERMAN HOME CARE SERVICES PRIVATE DIVISION
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:
1831131200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9909 US HWY 441
Provider Second Line Business Mailing Address:
UNIT 2 SUITE B
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-253-3900
Provider Business Mailing Address Fax Number:
352-253-3901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9909 US HWY 441
Provider Second Line Business Practice Location Address:
UNIT 2 SUITE B
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-253-3900
Provider Business Practice Location Address Fax Number:
352-253-3901
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARREN
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
352-253-3521

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA206360961 , 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: 6507735-79 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6754864-96 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6507735-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6754864-03 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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