MEDICARE: INTERIM HEALTHCARE OF NW FL INC

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	251E00000X	Home Health Agency	21548096	FL

General Provider Information

NPI Number	:	1871654210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERIM HEALTHCARE OF NW FL INC

Provider Business Mailing Address
First Line	:	2679 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4351
Country	:	US
Telephone Number	:	850-747-0080
Fax Number	:	850-747-0920

Provider Business Practice Location Address
First Line	:	2679 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4351
Country	:	US
Telephone Number	:	850-747-0080
Fax Number	:	850-747-0920

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. CYNTHIA ANNE LAVOIE
Credential	:
Telephone Number	:	850-747-0080

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/22/2020

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