MEDICARE: LADY SPEARHEAD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	233379	FL
2	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770963019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADY SPEARHEAD, LLC

Provider Business Mailing Address
First Line	:	10033 SAWGRASS DR W
Second Line	:	SUITE 209
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-3564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10033 SAWGRASS DR W
Second Line	:	SUITE 209
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-3564
Country	:	US
Telephone Number	:	904-834-2474
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	JAYNE BOGDAJEWICZ
Credential	:
Telephone Number	:	904-834-2474

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	07/30/2024

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