Healthcare Provider Details

I. General information

NPI: 1285243550
Provider Name (Legal Business Name): HATTIE'S PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 NW 187TH ST
MIAMI GARDENS FL
33056-3107
US

IV. Provider business mailing address

2950 NW 187TH ST
MIAMI GARDENS FL
33056-3107
US

V. Phone/Fax

Practice location:
  • Phone: 786-474-7494
  • Fax: 954-986-6854
Mailing address:
  • Phone: 786-474-7494
  • Fax: 954-986-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: HATTIE ALLEN
Title or Position: OWNER
Credential:
Phone: 786-474-7494