Healthcare Provider Details

I. General information

NPI: 1265978290
Provider Name (Legal Business Name): RELIANT ACUTE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2017
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5781 LEE BLVD UNIT 105
LEHIGH ACRES FL
33971-6338
US

IV. Provider business mailing address

5781 LEE BLVD UNIT 105
LEHIGH ACRES FL
33971-6338
US

V. Phone/Fax

Practice location:
  • Phone: 239-265-9760
  • Fax: 239-491-9128
Mailing address:
  • Phone: 239-265-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. LANCE CHAD HAAS
Title or Position: ADMINISTRATIVE MANAGER/OWNER
Credential:
Phone: 239-265-9760