Provider Demographics
NPI:1376893891
Name:EXPRESS PENSACOLA HHA, INC.
Entity Type:Organization
Organization Name:EXPRESS PENSACOLA HHA, INC.
Other - Org Name:CHAMPION HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KALISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-328-1607
Mailing Address - Street 1:910 AIRPORT RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2805
Mailing Address - Country:US
Mailing Address - Phone:850-460-2108
Mailing Address - Fax:850-460-2106
Practice Address - Street 1:910 AIRPORT RD
Practice Address - Street 2:SUITE A1
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2805
Practice Address - Country:US
Practice Address - Phone:850-460-2108
Practice Address - Fax:850-460-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994035251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health