Provider Demographics
NPI:1467449660
Name:CENTRAL FLORIDA HEALTH CARE, INC.
Entity Type:Organization
Organization Name:CENTRAL FLORIDA HEALTH CARE, INC.
Other - Org Name:CENTRAL FLORIDA HEALTH CARE FROSTPROOF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-291-5110
Mailing Address - Street 1:47 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4672
Mailing Address - Country:US
Mailing Address - Phone:863-291-5110
Mailing Address - Fax:
Practice Address - Street 1:109 W WALL STREET
Practice Address - Street 2:
Practice Address - City:FROSTPROOF
Practice Address - State:FL
Practice Address - Zip Code:33843-2043
Practice Address - Country:US
Practice Address - Phone:863-635-4891
Practice Address - Fax:863-635-3545
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL FLORIDA HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-03
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029549300Medicaid
FL77069AMedicare PIN
FL101851Medicare PIN