Provider Demographics
NPI:1003901687
Name:ALL CITY FAMILY HEALTH CORP
Entity Type:Organization
Organization Name:ALL CITY FAMILY HEALTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORDONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-584-1229
Mailing Address - Street 1:4721 E MOODY BLVD
Mailing Address - Street 2:BLDG 1 SUITE 103
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-7706
Mailing Address - Country:US
Mailing Address - Phone:386-586-1229
Mailing Address - Fax:386-586-2887
Practice Address - Street 1:4721 E MOODY BLVD
Practice Address - Street 2:BLDG 1 SUITE 103
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-7706
Practice Address - Country:US
Practice Address - Phone:386-586-1229
Practice Address - Fax:386-586-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00307040OtherRAILROAD MEDICARE
FLGK4OtherFL BLUE SHIELD
FL684885Medicare ID - Type UnspecifiedCORF