Provider Demographics
NPI:1285644245
Name:FLORIDA FIRST CARE D-4, INC.
Entity type:Organization
Organization Name:FLORIDA FIRST CARE D-4, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ENGELBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-537-8359
Mailing Address - Street 1:2233 PARK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5570
Mailing Address - Country:US
Mailing Address - Phone:904-269-6868
Mailing Address - Fax:904-269-9898
Practice Address - Street 1:2233 PARK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5570
Practice Address - Country:US
Practice Address - Phone:904-269-6868
Practice Address - Fax:904-269-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN283858OtherHEALTH EASE
FL107725Medicare ID - Type Unspecified