Provider Demographics
NPI:1265773592
Name:HEALTH CARE CENTER FOR THE HOMELESS, INC.
Entity type:Organization
Organization Name:HEALTH CARE CENTER FOR THE HOMELESS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BAKARI
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, MBA
Authorized Official - Phone:407-428-5751
Mailing Address - Street 1:232 N ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-1612
Mailing Address - Country:US
Mailing Address - Phone:407-428-5751
Mailing Address - Fax:407-428-6204
Practice Address - Street 1:150 W MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4463
Practice Address - Country:US
Practice Address - Phone:407-203-6856
Practice Address - Fax:407-203-6859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687429104Medicaid
FL687429105Medicaid
FLDQ397AMedicare PIN
FL687429105Medicaid