Provider Demographics
NPI:1518953579
Name:MEDERI OF ALACHUA COUNTY, INC.
Entity Type:Organization
Organization Name:MEDERI OF ALACHUA COUNTY, INC.
Other - Org Name:MEDERI OF LAKE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:C.
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GUENTHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-891-1000
Mailing Address - Street 1:9510 ORMSBY STATION RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4081
Mailing Address - Country:US
Mailing Address - Phone:502-891-1000
Mailing Address - Fax:502-891-8067
Practice Address - Street 1:12106 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5514
Practice Address - Country:US
Practice Address - Phone:352-592-1424
Practice Address - Fax:352-592-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21822096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHD3OtherBLUE CROSS-BLUE SHIELD
FLHD3OtherBLUE CROSS-BLUE SHIELD