Healthcare Provider Details

I. General information

NPI: 1538204565
Provider Name (Legal Business Name): CARING HEARTS PEDIATRIC EXTENDED CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 UNIVERSITY PKWY
PENSACOLA FL
32514-5524
US

IV. Provider business mailing address

9020 UNIVERSITY PKWY
PENSACOLA FL
32514-5524
US

V. Phone/Fax

Practice location:
  • Phone: 850-475-0555
  • Fax: 850-475-0650
Mailing address:
  • Phone: 850-475-0555
  • Fax: 850-475-0650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2278P3900X
TaxonomyNeonatal/Pediatric Certified Respiratory Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. CYNTHIA DENISE CAMERON
Title or Position: ADMINISTRATOR
Credential: HEALTH CARE ADMIN
Phone: 850-475-0555