Provider Demographics
NPI:1952305237
Name:NORTHWEST FLORIDA HEALTHCARE, INC.
Entity Type:Organization
Organization Name:NORTHWEST FLORIDA HEALTHCARE, INC.
Other - Org Name:NORTHWEST FLORIDA COMMUNITY HOME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHLENKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-415-8103
Mailing Address - Street 1:1360 BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-6303
Mailing Address - Country:US
Mailing Address - Phone:850-638-3395
Mailing Address - Fax:850-638-3167
Practice Address - Street 1:1360 BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-6303
Practice Address - Country:US
Practice Address - Phone:850-415-8103
Practice Address - Fax:850-638-3167
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST FLORIDA HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-02
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA207700961251E00000X
FLHHA20766096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651050700Medicaid
FLH3ROtherPROVIDER ID
FL107401Medicare ID - Type UnspecifiedPROVIDER ID
FL107401Medicare Oscar/Certification