Healthcare Provider Details

I. General information

NPI: 1467953083
Provider Name (Legal Business Name): HEALTH CARE CENTER FOR THE HOMELESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W LIVINGSTON ST BLDG 800
ORLANDO FL
32805-1560
US

IV. Provider business mailing address

232 N ORANGE BLOSSOM TRL
ORLANDO FL
32805-1612
US

V. Phone/Fax

Practice location:
  • Phone: 407-428-5751
  • Fax:
Mailing address:
  • Phone: 407-428-5751
  • Fax: 407-428-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: BAKARI F BURNS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 407-428-5751