Provider Demographics
NPI:1073006631
Name:LIVING FLORIDA HEALTHCARE LLC
Entity Type:Organization
Organization Name:LIVING FLORIDA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-574-2121
Mailing Address - Street 1:4804 EDGEWATER DR STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1126
Mailing Address - Country:US
Mailing Address - Phone:407-574-2121
Mailing Address - Fax:866-682-4175
Practice Address - Street 1:4804 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1126
Practice Address - Country:US
Practice Address - Phone:321-330-9330
Practice Address - Fax:321-697-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care