Provider Demographics
NPI:1952644189
Name:ENVISTA HEALTH, L.L.C.
Entity Type:Organization
Organization Name:ENVISTA HEALTH, L.L.C.
Other - Org Name:ENVISTA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-252-2224
Mailing Address - Street 1:1810 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1645
Mailing Address - Country:US
Mailing Address - Phone:813-252-2224
Mailing Address - Fax:813-925-6924
Practice Address - Street 1:1810 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1645
Practice Address - Country:US
Practice Address - Phone:813-252-2224
Practice Address - Fax:813-925-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-06
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211638251B00000X
FL251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012169300Medicaid
FL30211638OtherAHCA