1053401513 NPI number — CARE HEALTH SERVICE OF FLORIDA, INC.

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 1053401513 NPI number — CARE HEALTH SERVICE OF FLORIDA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE HEALTH SERVICE OF FLORIDA, 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:
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:
1053401513
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:
1800 FOREST HILL BLVD
Provider Second Line Business Mailing Address:
SUITE B-1
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33406-6094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-433-8700
Provider Business Mailing Address Fax Number:
561-641-1168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
839 BARTON BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ROCKLEDGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32955-3127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-576-0351
Provider Business Practice Location Address Fax Number:
321-576-0354
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEALY
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
ALTON
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
561-433-8700

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)





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