MEDICARE: HOGANS BRIDGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	691570198	FL
2	251S00000X	Community/Behavioral Health Agency	691570198	FL
3	253Z00000X	In Home Supportive Care Agency	691570196	FL
4	251S00000X	Community/Behavioral Health Agency	691570196	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699917948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOGANS BRIDGE

Provider Business Mailing Address
First Line	:	12415 KILDEER RD
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34614-2804
Country	:	US
Telephone Number	:	352-597-4943
Fax Number	:	352-597-4943

Provider Business Practice Location Address
First Line	:	12415 KILDEER RD
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34614-2804
Country	:	US
Telephone Number	:	352-597-4943
Fax Number	:	352-597-4943

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINE E HOGAN
Credential	:
Telephone Number	:	352-597-4943

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	04/01/2009

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Directions to “HOGANS BRIDGE ” Practice Location

Language	Start Address	Practice Location

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