Provider Demographics
NPI:1831131200
Name:FLORIDA HOSPITAL WATERMAN INC
Entity Type:Organization
Organization Name:FLORIDA HOSPITAL WATERMAN INC
Other - Org Name:FLORIDA HOSPITAL WATERMAN HOME CARE SERVICES PRIVATE DIVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-253-3521
Mailing Address - Street 1:9909 US HWY 441
Mailing Address - Street 2:UNIT 2 SUITE B
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788
Mailing Address - Country:US
Mailing Address - Phone:352-253-3900
Mailing Address - Fax:352-253-3901
Practice Address - Street 1:9909 US HWY 441
Practice Address - Street 2:UNIT 2 SUITE B
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788
Practice Address - Country:US
Practice Address - Phone:352-253-3900
Practice Address - Fax:352-253-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA206360961251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6507735-79Medicaid
FL6754864-96Medicaid
FL6507735-00Medicaid
FL6754864-03Medicaid