Provider Demographics
NPI:1558684910
Name:SUNCREST HOME HEALTH OF CENTRAL FL, LLC
Entity Type:Organization
Organization Name:SUNCREST HOME HEALTH OF CENTRAL FL, LLC
Other - Org Name:SUNCREST OMNI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF LICENSING/ACCREDITATION
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFADDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-712-2250
Mailing Address - Street 1:510 HOSPITAL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5033
Mailing Address - Country:US
Mailing Address - Phone:615-627-9267
Mailing Address - Fax:615-577-0081
Practice Address - Street 1:994 DOUGLAS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2068
Practice Address - Country:US
Practice Address - Phone:407-328-9993
Practice Address - Fax:407-328-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992128251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004232000Medicaid
FL004232000Medicaid