Provider Demographics
NPI:1609648971
Name:OUR FAMILY HEALTH
Entity Type:Organization
Organization Name:OUR FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CICO/CO-CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER-HARGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-953-9734
Mailing Address - Street 1:10752 DEERWOOD PARK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4846
Mailing Address - Country:US
Mailing Address - Phone:407-953-9734
Mailing Address - Fax:
Practice Address - Street 1:10752 DEERWOOD PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4846
Practice Address - Country:US
Practice Address - Phone:407-953-9734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health