Provider Demographics
NPI:1407454762
Name:FLORIDA EXECUTIVE HEALTHCARE LLC
Entity Type:Organization
Organization Name:FLORIDA EXECUTIVE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-456-7080
Mailing Address - Street 1:1424 WHITEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5654
Mailing Address - Country:US
Mailing Address - Phone:386-456-7080
Mailing Address - Fax:
Practice Address - Street 1:1424 WHITEWOOD DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5654
Practice Address - Country:US
Practice Address - Phone:386-456-7080
Practice Address - Fax:386-200-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health