Provider Demographics
NPI:1730291667
Name:HEALTH CARE CENTER FOR THE HOMELESS INC
Entity Type:Organization
Organization Name:HEALTH CARE CENTER FOR THE HOMELESS INC
Other - Org Name:HEALTH CARE CENTER FOR HOMELESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BAKARI
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:407-428-5751
Mailing Address - Street 1:232 N ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-1612
Mailing Address - Country:US
Mailing Address - Phone:407-428-5751
Mailing Address - Fax:407-428-6204
Practice Address - Street 1:232 N ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1612
Practice Address - Country:US
Practice Address - Phone:407-428-5751
Practice Address - Fax:407-428-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH218093336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2007088OtherPK
FL687429100Medicaid
101963Medicare ID - Type Unspecified