Provider Demographics
NPI:1033264205
Name:VITAS HEALTHCARE CORPORATION OF FLORIDA
Entity Type:Organization
Organization Name:VITAS HEALTHCARE CORPORATION OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-374-4143
Mailing Address - Street 1:3046 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6547
Mailing Address - Country:US
Mailing Address - Phone:305-350-6756
Mailing Address - Fax:305-350-6993
Practice Address - Street 1:2381 MASON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5162
Practice Address - Country:US
Practice Address - Phone:386-671-2792
Practice Address - Fax:386-615-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50370969251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL602600Medicaid
FL602600Medicaid