Provider Demographics
NPI:1740934165
Name:MIDWAY GROUP HOME
Entity type:Organization
Organization Name:MIDWAY GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VAIDWATTEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMJIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-216-2266
Mailing Address - Street 1:2 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-9679
Mailing Address - Country:US
Mailing Address - Phone:352-216-2266
Mailing Address - Fax:
Practice Address - Street 1:2 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-9679
Practice Address - Country:US
Practice Address - Phone:352-216-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004959400Medicaid