Provider Demographics
NPI:1881678605
Name:MOORINGS PARK COMMUNITY HEALTH, INC.
Entity Type:Organization
Organization Name:MOORINGS PARK COMMUNITY HEALTH, INC.
Other - Org Name:MOORINGS PARK HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVENDER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:239-643-9152
Mailing Address - Street 1:120 MOORINGS PARK DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-2122
Mailing Address - Country:US
Mailing Address - Phone:239-643-9152
Mailing Address - Fax:239-643-9196
Practice Address - Street 1:120 MOORINGS PARK DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-2122
Practice Address - Country:US
Practice Address - Phone:239-643-9152
Practice Address - Fax:239-643-9196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA 299991484251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108175Medicare Oscar/Certification