Healthcare Provider Details

I. General information

NPI: 1376539155
Provider Name (Legal Business Name): MEDERI OF ORANGE COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 PORT MALABAR BLVD NE SUITE 205
PALM BAY FL
32905-5161
US

IV. Provider business mailing address

9510 ORMSBY STATION RD SUITE 300
LOUISVILLE KY
40223-4081
US

V. Phone/Fax

Practice location:
  • Phone: 321-308-0321
  • Fax: 321-308-0329
Mailing address:
  • Phone: 502-891-1000
  • Fax: 502-891-8067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number21635096
License Number StateFL

VIII. Authorized Official

Name: MR. C. STEVEN GUENTHNER
Title or Position: SR. VP,CFO
Credential:
Phone: 502-891-1042