Provider Demographics
NPI:1588859623
Name:HENDRY COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:HENDRY COUNTY HOSPITAL AUTHORITY
Other - Org Name:HENDRY REGIONAL CONVENIENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:CUDWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-902-3076
Mailing Address - Street 1:450 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-4629
Mailing Address - Country:US
Mailing Address - Phone:863-675-2356
Mailing Address - Fax:863-675-2407
Practice Address - Street 1:450 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4629
Practice Address - Country:US
Practice Address - Phone:863-675-2356
Practice Address - Fax:863-675-2407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health