Provider Demographics
NPI:1639149180
Name:DELTONA HEALTH CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:DELTONA HEALTH CARE ASSOCIATES LLC
Other - Org Name:DELTONA HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HILGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-789-3769
Mailing Address - Street 1:1851 ELKCAM BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-3922
Mailing Address - Country:US
Mailing Address - Phone:386-789-3769
Mailing Address - Fax:386-789-6232
Practice Address - Street 1:1851 ELKCAM BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-3922
Practice Address - Country:US
Practice Address - Phone:386-789-3769
Practice Address - Fax:386-789-6232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1125096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025215800Medicaid
FL025215800Medicaid