Healthcare Provider Details

I. General information

NPI: 1801764931
Provider Name (Legal Business Name): HEARTWELL HOME HEALTH CARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 79TH AVE STE 115-117
DORAL FL
33122-1073
US

IV. Provider business mailing address

2500 NW 79TH AVE STE 115-117
DORAL FL
33122-1073
US

V. Phone/Fax

Practice location:
  • Phone: 305-591-7898
  • Fax: 305-591-7112
Mailing address:
  • Phone: 305-591-7898
  • Fax: 305-591-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CLEMENTE SIERRA
Title or Position: CFO
Credential:
Phone: 786-542-5338