Healthcare Provider Details

I. General information

NPI: 1679369151
Provider Name (Legal Business Name): PINE HILLS HEALTHCARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2025
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 N PINE HILLS RD UNIT 104
ORLANDO FL
32808-7123
US

IV. Provider business mailing address

9542 SHEPARD PL
WELLINGTON FL
33414-6420
US

V. Phone/Fax

Practice location:
  • Phone: 561-929-6903
  • Fax: 561-584-6222
Mailing address:
  • Phone: 561-929-6903
  • Fax: 561-584-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAGMOHAN VIROJA
Title or Position: PRESIDENT
Credential: MD
Phone: 561-929-6903