Provider Demographics
NPI:1104080142
Name:RAWLINS MED-WAIVER PROVIDER AGENCY
Entity type:Organization
Organization Name:RAWLINS MED-WAIVER PROVIDER AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAWLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-871-4613
Mailing Address - Street 1:640 CECINA WAY APT A
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3287
Mailing Address - Country:US
Mailing Address - Phone:352-871-4613
Mailing Address - Fax:
Practice Address - Street 1:640 CECINA WAY APT A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3287
Practice Address - Country:US
Practice Address - Phone:352-871-4613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL690683496251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health