Provider Demographics
NPI:1487187571
Name:PHCA ADMINISTRATION,LLC
Entity Type:Organization
Organization Name:PHCA ADMINISTRATION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHCA ADMINISTRATION, LLC, C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-854-2003
Mailing Address - Street 1:4033 TAMPA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3224
Mailing Address - Country:US
Mailing Address - Phone:813-854-2003
Mailing Address - Fax:813-855-2367
Practice Address - Street 1:4033 TAMPA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3224
Practice Address - Country:US
Practice Address - Phone:813-854-2003
Practice Address - Fax:813-855-2367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVELLE HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty