Healthcare Provider Details

I. General information

NPI: 1437940947
Provider Name (Legal Business Name): HEALING HORIZONS 101, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2648 RAVENALL AVE
ORLANDO FL
32811-5544
US

IV. Provider business mailing address

2648 RAVENALL AVE
ORLANDO FL
32811-5544
US

V. Phone/Fax

Practice location:
  • Phone: 321-710-4088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE MONTGOMERY
Title or Position: CEO
Credential:
Phone: 407-272-1806