Basic Information
| Provider Information | |||||||||
| NPI: | 1053088476 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONNECT TO CARE OF FLORIDA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 W BEAVER ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322041415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046486200 | ||||||||
| FaxNumber: | 9046486300 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 W BEAVER ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322041415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046486200 | ||||||||
| FaxNumber: | 9046486300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2021 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | BRYANT | ||||||||
| AuthorizedOfficialFirstName: | CHARITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9046486200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 343900000X | Y | Transportation Services | Non-emergency Medical Transport (VAN) |
ID Information
| ID | Type | State | Issuer | Description | 111547500 | 05 | FL | MEDICAID |