Organization
COPROVIDERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL A. OSGOOD (OWNER)
(386) 697-1156
Entity
Organization
Contact information
Practice address
5987 112TH PL, LIVE OAK, FL 32060-7270
(386) 697-1156
(352) 271-4255
Mailing address
5987 112TH PL, LIVE OAK, FL 32060-7270
(386) 697-1156
(352) 271-4255
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
FL
251E00000X
Home Health Agency
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
581849
—
FL
Enumeration date
03/04/2015
Last updated
03/04/2015
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