Provider Demographics
NPI:1225337819
Name:CENTRAL FLORIDA HEALTH CARE, INC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA HEALTH CARE, INC
Other - Org Name:CENTRAL FLORIDA HEALTH CARE, INC. - 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:863-452-3012
Mailing Address - Fax:863-291-5124
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:863-678-4360
Practice Address - Fax:863-678-4399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL FLORIDA HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-22
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691835206OtherMEDICAID FQHC
FL77069BOtherMEDICARE FFS