Provider Demographics
NPI:1023045853
Name:FLORIDA HOSPITAL WATERMAN INC
Entity Type:Organization
Organization Name:FLORIDA HOSPITAL WATERMAN INC
Other - Org Name:HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-253-3521
Mailing Address - Street 1:9909 US HWY 441
Mailing Address - Street 2:UNIT 2 SUITE A
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788
Mailing Address - Country:US
Mailing Address - Phone:352-253-3900
Mailing Address - Fax:352-253-3901
Practice Address - Street 1:9909 US HWY 441
Practice Address - Street 2:UNIT 2 SUITE A
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788
Practice Address - Country:US
Practice Address - Phone:352-253-3900
Practice Address - Fax:352-253-3901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-27
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA212820961251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107155OtherUNITED HEALTH CARE
FL675486403OtherMID FL AGENCY ON AGING
FL107155OtherPACIFICARE MCR
FL107155OtherKEYSTONE HP WEST MCR
FLH1VOtherBLUE CROSS
FL027111000Medicaid
FL107155OtherFL HEALTH CARE PLANS MCR
FL107155OtherKEYSTONE HP WEST MCR
FL107155Medicare Oscar/Certification