Provider Demographics
NPI:1285620146
Name:MEDERI OF COLLIER COUNTY, INC.
Entity type:Organization
Organization Name:MEDERI OF COLLIER COUNTY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:C.
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GUENTHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-891-1000
Mailing Address - Street 1:9510 ORMSBY STATION RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4081
Mailing Address - Country:US
Mailing Address - Phone:502-891-1000
Mailing Address - Fax:502-891-8067
Practice Address - Street 1:2509 RIO DE JANEIRO AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-8667
Practice Address - Country:US
Practice Address - Phone:941-764-7555
Practice Address - Fax:941-764-9533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21996096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ9IOtherBLUE CROSS-BLUE SHIELD
FL10-7485Medicare ID - Type UnspecifiedHOME HEALTH