Healthcare Provider Details

I. General information

NPI: 1972272979
Provider Name (Legal Business Name): HEARTWELL HOME HEALTH CARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 79TH AVE STE 116
DORAL FL
33122-1075
US

IV. Provider business mailing address

2500 NW 79TH AVE STE 116
DORAL FL
33122-1075
US

V. Phone/Fax

Practice location:
  • Phone: 305-591-7898
  • Fax:
Mailing address:
  • Phone: 305-591-7898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SIUSKA GONZALEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-591-7898