Provider Demographics
NPI:1962839761
Name:GORDON HOME HEALTH MINISTRIES INC
Entity Type:Organization
Organization Name:GORDON HOME HEALTH MINISTRIES INC
Other - Org Name:CENTRAL FLORIDA PHYSICIAN HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDRIS
Authorized Official - Middle Name:I
Authorized Official - Last Name:DALY-GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, EDD
Authorized Official - Phone:407-591-9353
Mailing Address - Street 1:PO BOX 951911
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-1911
Mailing Address - Country:US
Mailing Address - Phone:407-591-9353
Mailing Address - Fax:407-804-9517
Practice Address - Street 1:962 CHERRY BRANCH CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1944
Practice Address - Country:US
Practice Address - Phone:407-591-9353
Practice Address - Fax:407-804-9517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMY1STCOMPANYOtherMEDICARE PTAM # HR893A