Provider Demographics
NPI:1811058266
Name:INTERIM HEALTHCARE OF NW FL INC
Entity type:Organization
Organization Name:INTERIM HEALTHCARE OF NW FL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:REAK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:850-243-1152
Mailing Address - Street 1:339 RACETRACK RD NW
Mailing Address - Street 2:SUITE 16
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1538
Mailing Address - Country:US
Mailing Address - Phone:850-243-1152
Mailing Address - Fax:850-862-8548
Practice Address - Street 1:339 RACETRACK RD NW
Practice Address - Street 2:SUITE 16
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1538
Practice Address - Country:US
Practice Address - Phone:850-243-1152
Practice Address - Fax:850-862-8548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health