Provider Demographics
NPI:1457553273
Name:FIRST HEALTH RESOURCES CORPORATION
Entity Type:Organization
Organization Name:FIRST HEALTH RESOURCES CORPORATION
Other - Org Name:FAMILY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENANO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:863-983-3700
Mailing Address - Street 1:1133 BAL HARBOR BLVD UNIT 1139 PMB 260
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-6574
Mailing Address - Country:US
Mailing Address - Phone:863-983-3700
Mailing Address - Fax:863-983-9883
Practice Address - Street 1:820 W SUGARLAND HWY STE E-8
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-2700
Practice Address - Country:US
Practice Address - Phone:863-983-3700
Practice Address - Fax:863-983-9883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107562Medicare ID - Type UnspecifiedHOME HEALTH AGENCY