Basic Information
| Provider Information | |||||||||
| NPI: | 1790415131 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCENSION HEALTH AT HOME OF FLORIDA III, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CADILLAC DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370271001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178414834 | ||||||||
| FaxNumber: | 8669558538 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 S HIGHWAY 77 STE 203A | ||||||||
| Address2: | |||||||||
| City: | LYNN HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324444641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502501366 | ||||||||
| FaxNumber: | 8505884974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2022 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | ADKINS | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP, CHIEF LEGAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6153095668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.