1952305237 NPI number — NORTHWEST FLORIDA HEALTHCARE, INC.

Table of content: (NPI 1952305237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952305237 NPI number — NORTHWEST FLORIDA HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST FLORIDA HEALTHCARE, 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:
NORTHWEST FLORIDA COMMUNITY HOME HEALTH
Provider Other Organization Name Type Code:
5
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:
1952305237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1360 BRICKYARD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHIPLEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32428-6303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-638-3395
Provider Business Mailing Address Fax Number:
850-638-3167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1360 BRICKYARD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHIPLEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32428-6303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-415-8103
Provider Business Practice Location Address Fax Number:
850-638-3167
Provider Enumeration Date:
06/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHLENKER
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
850-415-8103

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA207700961 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: HHA20766096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 651050700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: H3R . This is a "PROVIDER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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