Organization
ALL CITY FAMILY HEALTH CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC M ORDONEZ (OWNER)
(386) 584-1229
Entity
Organization
Contact information
Practice address
4721 E MOODY BLVD, BLDG 1 SUITE 103, BUNNELL, FL 32110-7706
(386) 586-1229
(386) 586-2887
Mailing address
4721 E MOODY BLVD, BLDG 1 SUITE 103, BUNNELL, FL 32110-7706
(386) 586-1229
(386) 586-2887
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GK4
FL BLUE SHIELD
FL
01
—
P00307040
RAILROAD MEDICARE
FL
Enumeration date
10/03/2006
Last updated
07/30/2015
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