Organization · NPI-2

Athena Health Care Center INC

Family Medicine, Geriatric Medicine · Lakeland, FL

NPI number1083004287
StatusActive
Last updated in NPPESSep 3, 2015

Details

NPI
1083004287
Entity type
Organization (NPI-2)
Legal business name
Athena Health Care Center INC
Organization subpart
No
Enumeration date
Jan 27, 2015
Last updated
Sep 3, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207QG0300X Family Medicine, Geriatric MedicineME115832FLYes

Practice location

4240 Lakeland Highlands Rd
Lakeland, FL 33813-3113

Phone 863-646-8699

Mailing address

5714 Vintage View Blvd
Lakeland, FL 33812-5067

Authorized official

Amaury Guerra Gutierrez
President
3057425026

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