Healthcare Provider Details

I. General information

NPI: 1649630518
Provider Name (Legal Business Name): INDEPENDENCE FOR FLORIDA HOME HEALTH. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5719 RIORDAN WAY
ORLANDO FL
32808-2433
US

IV. Provider business mailing address

PO BOX 682474
ORLANDO FL
32868-2474
US

V. Phone/Fax

Practice location:
  • Phone: 407-757-5455
  • Fax: 321-800-6803
Mailing address:
  • Phone: 407-757-5455
  • Fax: 321-800-6803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberCNA283280
License Number StateFL

VIII. Authorized Official

Name: TANYA BLAKE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 407-844-1782