Healthcare Provider Details

I. General information

NPI: 1659616068
Provider Name (Legal Business Name): COMMUNITY HOME CARE PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 SW 110TH ST
GAINESVILLE FL
32607-3290
US

IV. Provider business mailing address

1924 SW 110TH ST
GAINESVILLE FL
32607-3290
US

V. Phone/Fax

Practice location:
  • Phone: 352-682-2195
  • Fax:
Mailing address:
  • Phone: 352-682-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME93246
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberME93246
License Number StateFL

VIII. Authorized Official

Name: RANJEEV SALWAN
Title or Position: CEO
Credential:
Phone: 352-682-2195