Provider Demographics
NPI:1720047640
Name:AMERICARE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:AMERICARE HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-241-5310
Mailing Address - Street 1:PO BOX 51582
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32240-1582
Mailing Address - Country:US
Mailing Address - Phone:904-241-5310
Mailing Address - Fax:904-247-9145
Practice Address - Street 1:478 OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4082
Practice Address - Country:US
Practice Address - Phone:904-241-5310
Practice Address - Fax:904-247-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNOT REQUIRED332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90712308Medicaid
LA1954268Medicaid
VA010065097Medicaid
AR134776741Medicaid
LA1954268Medicaid