Provider Demographics
NPI:1417067000
Name:TRADITIONAL MEDICAL HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:TRADITIONAL MEDICAL HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS, ACLS
Authorized Official - Phone:863-512-2622
Mailing Address - Street 1:342 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3046
Mailing Address - Country:US
Mailing Address - Phone:863-512-2622
Mailing Address - Fax:
Practice Address - Street 1:342 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3046
Practice Address - Country:US
Practice Address - Phone:863-512-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health