Provider Demographics
NPI:1316250152
Name:FLORIDA WEST HOME CARE, INC.
Entity type:Organization
Organization Name:FLORIDA WEST HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PLOTRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-465-7780
Mailing Address - Street 1:6973 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8207
Mailing Address - Country:US
Mailing Address - Phone:772-465-7780
Mailing Address - Fax:772-465-7783
Practice Address - Street 1:6973 HANCOCK DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-8207
Practice Address - Country:US
Practice Address - Phone:772-465-7780
Practice Address - Fax:772-465-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNR30211209251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30211209OtherNURSE REGISTRY
FL688636100OtherMEDICAID WAIVER
FL688636101OtherMEDICAID WAIVER