Healthcare Provider Details

I. General information

NPI: 1699917948
Provider Name (Legal Business Name): HOGANS BRIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12415 KILDEER RD
WEEKI WACHEE FL
34614-2804
US

IV. Provider business mailing address

12415 KILDEER RD
WEEKI WACHEE FL
34614-2804
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-4943
  • Fax: 352-597-4943
Mailing address:
  • Phone: 352-597-4943
  • Fax: 352-597-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number691570196
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number691570198
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number691570198
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number691570196
License Number StateFL

VIII. Authorized Official

Name: CHRISTINE E HOGAN
Title or Position: OWNER
Credential:
Phone: 352-597-4943