Basic Information
Provider Information | |||||||||
NPI: | 1366818270 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CENTRAL FLORIDA FAMILY HEALTH CENTER, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | TRUE HEALTH | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4930 E LAKE MARY BLVD | ||||||||
Address2: |   | ||||||||
City: | SANFORD | ||||||||
State: | FL | ||||||||
PostalCode: | 327715003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4073228645 | ||||||||
FaxNumber: | 4073305074 | ||||||||
Practice Location | |||||||||
Address1: | 1120 STATE ROAD 436 | ||||||||
Address2: | SUITE 1600 | ||||||||
City: | CASSELBERRY | ||||||||
State: | FL | ||||||||
PostalCode: | 32707 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4073228645 | ||||||||
FaxNumber: | 4073305074 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/14/2015 | ||||||||
LastUpdateDate: | 12/28/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DUNN | ||||||||
AuthorizedOfficialFirstName: | JANELLE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
AuthorizedOfficialTelephone: | 4073228645 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/28/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X |   | FL | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.