Provider Demographics
NPI:1235358995
Name:VITAS INNOVATIVE HOSPICE CARE
Entity Type:Organization
Organization Name:VITAS INNOVATIVE HOSPICE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEAM PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-670-6400
Mailing Address - Street 1:19901 VILLA TUSCANY DR
Mailing Address - Street 2:105
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-4106
Mailing Address - Country:US
Mailing Address - Phone:407-239-6220
Mailing Address - Fax:407-239-6220
Practice Address - Street 1:2075 LOCH LOMOND DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4183
Practice Address - Country:US
Practice Address - Phone:407-670-6400
Practice Address - Fax:407-670-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME023839251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49027Medicaid
FLME0023839OtherSTATE LICENSE
FLME0023839OtherSTATE LICENSE