Provider Demographics
NPI:1609823194
Name:SACRED HEART HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:SACRED HEART HEALTH SYSTEM INC
Other - Org Name:SACRED HEART HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-470-9288
Mailing Address - Street 1:213 E WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-4917
Mailing Address - Country:US
Mailing Address - Phone:850-470-9288
Mailing Address - Fax:850-470-9130
Practice Address - Street 1:213 E WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-4917
Practice Address - Country:US
Practice Address - Phone:850-470-9288
Practice Address - Fax:850-470-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA20476096251E00000X
FLHHA299990987251E00000X
FL1018332B00000X
AL2006-004168332B00000X
FLPH-00157943336H0001X
AL1123913336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009957250Medicaid
AL8200162OtherUNITED HEALTHCARE
FLJC1OtherBCBS OF FL - PHARMACY
FLP8234OtherNETBLUE - PHARMACY
MS02078367Medicaid
FL106340500Medicaid
AL51503539OtherBCBS AL - DME
FLR9043OtherBCBS OF FL - DME
FL106340501Medicaid
AL51518135OtherBCBS OF AL - PHARMACY
FLJC1OtherBCBS OF FL - NURSING
AL009957250Medicaid
FL106340500Medicaid
FLP8234OtherNETBLUE - PHARMACY
FLJC1OtherBCBS OF FL - PHARMACY
FL=========Medicare UPIN
FLJC1OtherBCBS OF FL - NURSING
AL51518135OtherBCBS OF AL - PHARMACY
FL106340501Medicaid