Healthcare Provider Details

I. General information

NPI: 1356148308
Provider Name (Legal Business Name): OUR CORNER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12505 STARKEY RD STE H
LARGO FL
33773
US

IV. Provider business mailing address

4604 49TH ST N STE 1093
SAINT PETERSBURG FL
33709-3842
US

V. Phone/Fax

Practice location:
  • Phone: 240-691-6971
  • Fax:
Mailing address:
  • Phone: 240-691-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: NHARI FITZGERALD
Title or Position: CEO
Credential:
Phone: 240-691-6971