Contract Details
Ancillary Care Services
Facility name
Request For Women
Provider ID
P000005847
Tax ID
593357575
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
12830 Southwest First Lane Suite 100
Newberry, FL 32669
United States
County
Alachua
Phone
3526922131 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address