Provider Demographics
NPI:1780844068
Name:FLORIDA WEST HOME CARE INC
Entity Type:Organization
Organization Name:FLORIDA WEST HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:DELAPENA
Authorized Official - Last Name:PLOTRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-340-5562
Mailing Address - Street 1:145 NW CENTRAL PARK PLAZA
Mailing Address - Street 2:SUITE 105 FLORIDA WEST HOME CARE INC
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986
Mailing Address - Country:US
Mailing Address - Phone:772-340-5742
Mailing Address - Fax:
Practice Address - Street 1:145 NW CENTRAL PARK PLAZA
Practice Address - Street 2:SUITE 105
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986
Practice Address - Country:US
Practice Address - Phone:772-340-5562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688636100Medicaid