Provider Demographics
NPI:1124028204
Name:THE HOSPICE OF THE FLORIDA SUNCOAST, INC.
Entity Type:Organization
Organization Name:THE HOSPICE OF THE FLORIDA SUNCOAST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUHAMID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-586-4432
Mailing Address - Street 1:5771 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3407
Mailing Address - Country:US
Mailing Address - Phone:727-586-4432
Mailing Address - Fax:727-523-3342
Practice Address - Street 1:5771 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3407
Practice Address - Country:US
Practice Address - Phone:727-586-4432
Practice Address - Fax:727-523-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5032096207R00000X, 251G00000X
FL21175096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027988903Medicaid
FL0279889-00Medicaid
FL027988901Medicaid
FL027988979Medicaid
FL087532508Medicaid
FL682498696Medicaid
FL087532500Medicaid
FL682498696Medicaid
FL101508Medicare Oscar/Certification