Provider Demographics
NPI:1497105654
Name:AMAZ'N HEALTHCARE
Entity Type:Organization
Organization Name:AMAZ'N HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-270-4674
Mailing Address - Street 1:2820 LAKE SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3059
Mailing Address - Country:US
Mailing Address - Phone:407-270-4674
Mailing Address - Fax:407-270-4801
Practice Address - Street 1:927 S GOLDWYN AVE
Practice Address - Street 2:SUITE 227
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-4324
Practice Address - Country:US
Practice Address - Phone:407-270-4674
Practice Address - Fax:407-270-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692219896OtherMEDICAID WAIVER