Provider Demographics
NPI:1467449249
Name:WEST ORANGE HEALTHCARE DISTRICT
Entity Type:Organization
Organization Name:WEST ORANGE HEALTHCARE DISTRICT
Other - Org Name:HEALTH CENTRAL PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOWETT
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:407-296-1614
Mailing Address - Street 1:411 N DILLARD ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2816
Mailing Address - Country:US
Mailing Address - Phone:407-296-1600
Mailing Address - Fax:407-296-1639
Practice Address - Street 1:411 N DILLARD ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2816
Practice Address - Country:US
Practice Address - Phone:407-296-1600
Practice Address - Fax:407-296-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF15940961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105479Medicare ID - Type Unspecified
FL5479Medicare PIN
FL0718720001Medicare PIN