Healthcare Provider Details

I. General information

NPI: 1689942948
Provider Name (Legal Business Name): CROHNS DISEASE FOUNDATION OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 HOLLIDAY AVE
APOPKA FL
32703-6636
US

IV. Provider business mailing address

3216 HOLLIDAY AVE
APOPKA FL
32703-6636
US

V. Phone/Fax

Practice location:
  • Phone: 407-574-8167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberT512836864550
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS REED THOMPSON
Title or Position: DIRECTOR
Credential:
Phone: 407-574-8167