Provider Demographics
NPI:1144762014
Name:ALL CHARACTER CARE
Entity Type:Organization
Organization Name:ALL CHARACTER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-721-3793
Mailing Address - Street 1:13900 COUNTY ROAD 455
Mailing Address - Street 2:SUITE 107-404
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-9052
Mailing Address - Country:US
Mailing Address - Phone:310-721-3793
Mailing Address - Fax:
Practice Address - Street 1:13900 COUNTY ROAD 455
Practice Address - Street 2:SUITE 107-404
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-9052
Practice Address - Country:US
Practice Address - Phone:352-404-7815
Practice Address - Fax:352-404-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207KA0200X, 208000000X, 2080A0000X, 208D00000X
FL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277908100Medicaid