Provider Demographics
NPI:1821085523
Name:VALLACARE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:VALLACARE HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLADARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-575-1333
Mailing Address - Street 1:517 TAMIAMI TRL
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5520
Mailing Address - Country:US
Mailing Address - Phone:941-575-1333
Mailing Address - Fax:941-575-7755
Practice Address - Street 1:517 TAMIAMI TRL
Practice Address - Street 2:SUITE A
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5520
Practice Address - Country:US
Practice Address - Phone:941-575-1333
Practice Address - Fax:941-575-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21384Medicare ID - Type Unspecified