Provider Demographics
NPI:1871654210
Name:INTERIM HEALTHCARE OF NW FL INC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF NW FL INC
Other - Org Name:INTERIM HEALTHCARE PANAMA CITY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:LAVOIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-747-0080
Mailing Address - Street 1:2679 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4351
Mailing Address - Country:US
Mailing Address - Phone:850-747-0080
Mailing Address - Fax:850-747-0920
Practice Address - Street 1:2679 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4351
Practice Address - Country:US
Practice Address - Phone:850-747-0080
Practice Address - Fax:850-747-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21548096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health