Provider Demographics
NPI:1467752998
Name:CENTRAL FLORIDA HEALTH CARE INC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA HEALTH CARE INC
Other - Org Name:CENTRAL FLORIDA HEALTH CARE - WINTER HAVEN CENTER
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:863-452-3000
Mailing Address - Fax:863-452-3069
Practice Address - Street 1:1514 1ST ST N
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2476
Practice Address - Country:US
Practice Address - Phone:863-452-3000
Practice Address - Fax:863-452-3069
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL FLORIDA HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-01
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QF0400X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691835204OtherMEDICAID FQHC
FL691835205OtherMEDICAID MEDICAL
FL77069AOtherMEDICARE