Healthcare Provider Details

I. General information

NPI: 1043763139
Provider Name (Legal Business Name): CENTRAL FLORIDA HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W CENTRAL AVE
LAKE WALES FL
33853-4015
US

IV. Provider business mailing address

47 5TH ST NW
WINTER HAVEN FL
33881-4672
US

V. Phone/Fax

Practice location:
  • Phone: 863-676-0054
  • Fax: 863-676-0079
Mailing address:
  • Phone: 863-268-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANN CLAUSSEN
Title or Position: CEO
Credential:
Phone: 863-291-5110