Provider Demographics
NPI:1720247588
Name:CENTRAL FLORIDA HEALTH CARE, INC.
Entity Type:Organization
Organization Name:CENTRAL FLORIDA HEALTH CARE, INC.
Other - Org Name:CENTRAL FLORIDA HEALTH CARE - DUNDEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-291-5110
Mailing Address - Street 1:47 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4672
Mailing Address - Country:US
Mailing Address - Phone:863-291-5110
Mailing Address - Fax:
Practice Address - Street 1:916 DUNDEE RD
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4198
Practice Address - Country:US
Practice Address - Phone:863-419-3330
Practice Address - Fax:863-419-8651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL FLORIDA HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-06
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL681471901OtherMEDICAID MEDICAL FFS