Provider Demographics
NPI:1750323473
Name:ISLAND HOME RESPIRATORY CARE INC.
Entity Type:Organization
Organization Name:ISLAND HOME RESPIRATORY CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-553-6732
Mailing Address - Street 1:4711 US HIGHWAY 17
Mailing Address - Street 2:UNIT 1
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8233
Mailing Address - Country:US
Mailing Address - Phone:904-553-6732
Mailing Address - Fax:904-264-5801
Practice Address - Street 1:4711 US HIGHWAY 17
Practice Address - Street 2:UNIT 1
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-8233
Practice Address - Country:US
Practice Address - Phone:904-553-6732
Practice Address - Fax:904-264-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATT-0007659227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5779470001Medicare NSC