Healthcare Provider Details

I. General information

NPI: 1619033750
Provider Name (Legal Business Name): HEHLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 SOLANO CAY CIR
PONTE VEDRA BEACH FL
32082-2242
US

IV. Provider business mailing address

117 SOLANO CAY CIR
PONTE VEDRA BEACH FL
32082-2242
US

V. Phone/Fax

Practice location:
  • Phone: 904-543-1778
  • Fax: 904-543-1755
Mailing address:
  • Phone: 904-543-1778
  • Fax: 904-543-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number229797
License Number StateFL

VIII. Authorized Official

Name: MS. HEIDI ELIZABETH HARE
Title or Position: OWNER
Credential: RN
Phone: 904-543-1778