1780617704 NPI number — ADVENTHEALTH HOME HEALTH AND HOSPICE INC

Table of content: (NPI 1780617704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780617704 NPI number — ADVENTHEALTH HOME HEALTH AND HOSPICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVENTHEALTH HOME HEALTH AND HOSPICE 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:
1780617704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13925 17TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DADE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33525-4603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-779-6301
Provider Business Mailing Address Fax Number:
813-779-6319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13925 17TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DADE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33525-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-779-6301
Provider Business Practice Location Address Fax Number:
813-779-6319
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHEELER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
530-545-1409

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA299992090 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 108170 . This is a "UNITED HEALTH MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 108170 . This is a "WELLCARE MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 533 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 108170 . This is a "UNIVERSAL HEALTHCARE MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 108170 . This is a "KEYSTONE HP WEST MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 108170 . This is a "HUMANA GOLD PLUS HMO MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 108170 . This is a "HUMANA GOLD CHC MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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