Provider Demographics
NPI:1043763139
Name:CENTRAL FLORIDA HEALTH CARE, INC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA HEALTH CARE, INC
Other - Org Name:CENTRAL FLORIDA HEALTH CARE PHARMACY LAKE WALES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-291-5110
Mailing Address - Street 1:47 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4672
Mailing Address - Country:US
Mailing Address - Phone:863-268-7850
Mailing Address - Fax:
Practice Address - Street 1:305 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4015
Practice Address - Country:US
Practice Address - Phone:863-676-0054
Practice Address - Fax:863-676-0079
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL FLORIDA HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-26
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X, 333600000X
FLPH30256333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162227OtherPK