Provider Demographics
NPI:1346663325
Name:HEALTH CARE CENTER FOR THE HOMELESS, INC.
Entity Type:Organization
Organization Name:HEALTH CARE CENTER FOR THE HOMELESS, INC.
Other - Org Name:ORANGE BLOSSOM FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BAKARI
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-428-5751
Mailing Address - Street 1:232 N ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-1612
Mailing Address - Country:US
Mailing Address - Phone:407-428-5751
Mailing Address - Fax:407-428-6204
Practice Address - Street 1:2711 N ORANGE BLOSSOM TRL STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1373
Practice Address - Country:US
Practice Address - Phone:407-428-5751
Practice Address - Fax:407-428-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687429107Medicaid
FL687429106Medicaid
FL687429106Medicaid
FLDQ397AMedicare PIN