Provider Demographics
NPI:1346584828
Name:JOHN KNOX VILLAGE OF CENTRAL FLORIDA, INC
Entity Type:Organization
Organization Name:JOHN KNOX VILLAGE OF CENTRAL FLORIDA, INC
Other - Org Name:JOHN KNOX VILLAGE OF CENTRAL FLORIDA HOME HEALTH AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-775-3840
Mailing Address - Street 1:101 NORTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-6167
Mailing Address - Country:US
Mailing Address - Phone:386-775-3840
Mailing Address - Fax:386-775-0456
Practice Address - Street 1:101 NORTHLAKE DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-6167
Practice Address - Country:US
Practice Address - Phone:386-775-3840
Practice Address - Fax:386-775-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20602096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-7530Medicare PIN
FL107530Medicare PIN