MEDICARE: HANA CARE INC

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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	OT6568	FL
2	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	PT9594	FL

General Provider Information

NPI Number	:	1912084294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANA CARE INC

Provider Business Mailing Address
First Line	:	1771 EDGEWOOD AVE W
Second Line	:	SUITE 6B
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-3278
Country	:	US
Telephone Number	:	904-768-9966
Fax Number	:	904-367-8760

Provider Business Practice Location Address
First Line	:	1771 EDGEWOOD AVE W
Second Line	:	SUITE 6B
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-3278
Country	:	US
Telephone Number	:	904-768-9966
Fax Number	:	904-765-1655

Authorized Official
Title or Position	:	CEO
Name	:	MISS NIEMAT M ISSA
Credential	:	OTR/L
Telephone Number	:	904-768-9966

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/05/2017

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Directions to “HANA CARE INC ” Practice Location

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