| Details | Last Recertification Date | Update | Recertification | 2/28/2024 2:25:11 PM | 3/3/2025 11:52:55 AM | 3/3/2025 11:52 AM |
| Addresses | Shipping Address | Insert | Recertification | | Central Florida Family Health Center, Inc. dba True Health
5730 Lake Underhill Rd
Orlando, FL 32807 | 2/28/2024 2:25 PM |
| Details | Last Recertification Date | Update | Recertification | 2/27/2023 11:39:37 AM | 2/28/2024 2:25:11 PM | 2/28/2024 2:25 PM |
| Details | Last Recertification Date | Update | Recertification | 2/14/2022 3:15:20 PM | 2/27/2023 11:39:37 AM | 2/27/2023 11:39 AM |
| Details | Last Recertification Date | Update | Recertification | 2/25/2021 5:14:58 PM | 2/14/2022 3:15:20 PM | 2/14/2022 3:15 PM |
| Details | Entity Subname | Update | Change Request | LAKE UNDERHILL FAMILY HLTH CTR | Lake Underhill Health Center | 7/16/2021 11:31 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | FL | 2/25/2021 5:14 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | FL | 2/25/2021 5:14 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | FL | 2/25/2021 5:14 PM |
| Details | Last Recertification Date | Update | Recertification | 1/27/2020 7:33:05 PM | 2/25/2021 5:14:58 PM | 2/25/2021 5:14 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Stewart, Latrice
CEO
Central Florida Family Health Center, Inc. dba True Health
4073228645-1015 | Dunn, Janelle A
CEO
Central Florida Family Health Center dba True Health
4073228645-1132 | 6/15/2020 5:07 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1396746988 | 4/15/2020 5:49 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 2/26/2020 10:56 AM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 029551504 | 2/26/2020 10:56 AM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | FL | 2/26/2020 10:56 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 2/26/2020 10:56 AM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 029551511 | 2/26/2020 10:56 AM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | FL | 2/26/2020 10:56 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1497786818 | 2/26/2020 10:56 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Mussari, Sabrina
Pharm.D.
Central Florida Family Health Center
4073228645-1023 | Mussari, Sabrina
Pharm.D.
Central Florida Family Health Center Inc, dba True Health
4073228645-1023 | 2/25/2020 4:36 PM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2019 10:07:34 AM | 1/27/2020 7:33:05 PM | 1/27/2020 7:33 PM |
| Contacts | Primary Contact | Update | Change Request | Boxer, Hylan
Director of Pharmacy
True Health
4073228653 | Mussari, Sabrina
Pharm.D.
Central Florida Family Health Center
4073228645-1023 | 2/12/2019 4:06 PM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2018 9:01:12 AM | 2/12/2019 10:07:34 AM | 2/12/2019 10:07 AM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2017 12:00:00 AM | 2/9/2018 9:01:12 AM | 2/9/2018 9:01 AM |
| Contacts | Primary Contact | Update | | Boxer, Hylan
Director of Pharmacy
4073228653 | Boxer, Hylan
Director of Pharmacy
True Health
4073228653 | 10/2/2017 8:12 AM |
| Contacts | Authorizing Official | Update | | Stewart, Latrice
CEO
4073228645-1015 | Stewart, Latrice
CEO
Central Florida Family Health Center, Inc. dba True Health
4073228645-1015 | 9/21/2017 1:13 PM |
| Contacts | Authorizing Official | Update | | Smith, Leslie
CEO/CMO
4073228645-1034 | Stewart, Latrice
CEO
4073228645-1015 | 5/22/2017 12:40 PM |
| Contacts | Primary Contact | Insert | | | Boxer, Hylan
Director of Pharmacy
4073228653 | 2/13/2017 6:51 AM |
| Addresses | Main Address | Insert | | |
5730 Lake Underhill Rd
Orlando, FL 32807-4366 | 2/8/2017 5:19 PM |
| Medicaid Billing | Medicaid: Is Primary | Update | | True | False | 2/8/2017 5:18 PM |
| Details | Last Recertification Date | Update | | 2/25/2016 12:00:00 AM | 2/8/2017 12:00:00 AM | 2/8/2017 5:18 PM |
| Addresses | Billing Address | Update | | CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.
2400 STATE ROAD 415
SANFORD, FL 32771 | True Health
4930 E Lake Mary Blvd
SANFORD, FL 32771 | 2/25/2016 9:34 AM |
| Details | Last Recertification Date | Update | | 2/12/2015 12:00:00 AM | 2/25/2016 12:00:00 AM | 2/25/2016 9:34 AM |
| Addresses | Billing Address | Insert | | | CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.
2400 STATE ROAD 415
SANFORD, FL 32771 | 2/25/2016 9:34 AM |
| Contacts | Authorizing Official | Update | | CAHILL, DENNIS W.
CEO
4073228645-239 | Smith, Leslie
CEO/CMO
4073228645-1034 | 2/12/2015 12:48 PM |
| Details | Last Recertification Date | Update | | 3/20/2014 12:00:00 AM | 2/12/2015 12:00:00 AM | 2/12/2015 12:48 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/20/2014 12:00:00 AM | 3/20/2014 2:53 PM |
| Details | Entity Subname | Update | | LAKE UNDERHILL | LAKE UNDERHILL FAMILY HLTH CTR | 3/20/2014 2:53 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1275693202 | 2/25/2013 8:40 AM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/25/2013 8:40 AM |
| Contacts | Authorizing Official | Insert | | | CAHILL, DENNIS W.
CEO
4073228645-239 | 1/21/2010 11:13 AM |
| Details | Last Recertification Date | Insert | | | | 1/30/2008 11:58 AM |
| Details | Grant Number | Insert | | | H80CS00178 | 1/30/2008 11:58 AM |
| Details | 340B ID | Insert | | | CH04172A | 1/30/2008 11:58 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/30/2008 11:58 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/30/2008 11:58 AM |
| Details | Medicare Provider Number | Insert | | | | 1/30/2008 11:58 AM |
| Details | Entity Name | Insert | | | CENTRAL FLORIDA FAMILY HEALTH CENTER, INC. | 1/30/2008 11:58 AM |
| Details | Program Code | Insert | | | CH | 1/30/2008 11:58 AM |
| Details | Entity Subname | Insert | | | LAKE UNDERHILL | 1/30/2008 11:58 AM |
| Dates | Participating Approval Date | Insert | | | 11/29/2006 12:00:00 AM | 1/30/2008 11:58 AM |
| Details | State | Insert | | | Active | 1/30/2008 11:58 AM |
| Dates | Registration Date | Insert | | | 11/28/2006 12:00:00 AM | 1/30/2008 11:58 AM |
| Dates | Signed By Date | Insert | | | 11/28/2006 12:00:00 AM | 1/30/2008 11:58 AM |
| Dates | Start Date | Insert | | | 1/1/2007 12:00:00 AM | 1/30/2008 11:58 AM |
| Terminations | Termination Comments | Insert | | | | 1/30/2008 11:58 AM |
| Terminations | Termination Date | Insert | | | | 1/30/2008 11:58 AM |
| Terminations | Termination Effective Date | Insert | | | | 1/30/2008 11:58 AM |
| Terminations | Termination Reason | Insert | | | | 1/30/2008 11:58 AM |
| Details | Comments Public | Insert | | | 1/30/08-UPDATED MEDICAID INFO. (WAS PENDING) | 1/30/2008 11:58 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | True | 11/28/2006 4:58 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 031930900 | 11/28/2006 4:58 PM |
| Medicaid Billing | Medicaid: State | Insert | | | FL | 11/28/2006 4:58 PM |