Basic Information
| Provider Information | |||||||||
| NPI: | 1043747967 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH CARE CENTER FOR THE HOMELESS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ORANGE BLOSSOM PEDIATRICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 232 N ORANGE BLOSSOM TRL | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328051612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074285751 | ||||||||
| FaxNumber: | 4074286204 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 WEST LIVINGSTON STREET | ||||||||
| Address2: | BUILDING 800 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328051535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074285751 | ||||||||
| FaxNumber: | 4074286204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BURNS | ||||||||
| AuthorizedOfficialFirstName: | BAKARI | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT / CEO | ||||||||
| AuthorizedOfficialTelephone: | 4074285751 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.