1801990429 NPI number — ADVENTHEALTH HOME HEALTH AND HOSPICE INC

Table of content: (NPI 1801990429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801990429 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:
1801990429
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:
770 W GRANADA BLVD STE 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORMOND BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32174-5180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-671-2138
Provider Business Mailing Address Fax Number:
386-672-0314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 W GRANADA BLVD STE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-5180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-671-2138
Provider Business Practice Location Address Fax Number:
386-672-0314
Provider Enumeration Date:
09/12/2006

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: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 315D00000X , with the licence number: 5039096 , 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: 592951991010 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 150003100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: U38 . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 150003100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com