MEDICARE: HEART 2 HEART BIRTH CENTER 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	261QB0400X	Birthing Clinic/Center	328	FL

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	:	1902096159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART 2 HEART BIRTH CENTER LLC

Provider Business Mailing Address
First Line	:	1110 LEXINGTON GREEN LN
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-1022
Country	:	US
Telephone Number	:	407-322-9944
Fax Number	:	407-878-5858

Provider Business Practice Location Address
First Line	:	1110 LEXINGTON GREEN LN
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-1022
Country	:	US
Telephone Number	:	407-322-9944
Fax Number	:	407-878-5858

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN MICHELLE GRAF
Credential	:	LM
Telephone Number	:	407-322-9944

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	01/24/2017

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Directions to “HEART 2 HEART BIRTH CENTER LLC ” Practice Location

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