Healthcare Provider Details

I. General information

NPI: 1407454762
Provider Name (Legal Business Name): FLORIDA EXECUTIVE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 WHITEWOOD DR
DELTONA FL
32725-5654
US

IV. Provider business mailing address

1424 WHITEWOOD DR
DELTONA FL
32725-5654
US

V. Phone/Fax

Practice location:
  • Phone: 386-456-7080
  • Fax: 386-200-5919
Mailing address:
  • Phone: 386-456-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GISELLE M VILLA
Title or Position: CEO/OWNER
Credential:
Phone: 386-456-7080