Healthcare Provider Details

I. General information

NPI: 1619584125
Provider Name (Legal Business Name): HARMONY FRUITION AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22513 SE 61ST AVE
HAWTHORNE FL
32640-3640
US

IV. Provider business mailing address

22513 SE 61ST AVE
HAWTHORNE FL
32640-3640
US

V. Phone/Fax

Practice location:
  • Phone: 352-234-5738
  • Fax:
Mailing address:
  • Phone: 352-234-5738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE LATOYA JOHNSON
Title or Position: OWNER
Credential: LICENSED
Phone: 352-234-5738