Healthcare Provider Details

I. General information

NPI: 1104272970
Provider Name (Legal Business Name): RICH AT HEART HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 NE 52ND TER
GAINESVILLE FL
32609-1216
US

IV. Provider business mailing address

7501 NE 52ND TER
GAINESVILLE FL
32609-1216
US

V. Phone/Fax

Practice location:
  • Phone: 352-575-7963
  • Fax:
Mailing address:
  • Phone: 352-575-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TIJUANA SHEREE IRVING
Title or Position: OWNER
Credential:
Phone: 352-575-7963