Provider Demographics
NPI:1922781632
Name:PENINSULAR HEALTH LLC
Entity Type:Organization
Organization Name:PENINSULAR HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HEEKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-790-0275
Mailing Address - Street 1:4929 LEGACY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-2069
Mailing Address - Country:US
Mailing Address - Phone:407-790-0275
Mailing Address - Fax:
Practice Address - Street 1:4929 LEGACY OAKS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-2069
Practice Address - Country:US
Practice Address - Phone:407-790-0275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health