Healthcare Provider Details

I. General information

NPI: 1780643320
Provider Name (Legal Business Name): HEALING HANDS GROUP HOMES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

973 SE BROWNING AVE
PORT ST LUCIE FL
34983-3937
US

IV. Provider business mailing address

973 SE BROWNING AVE
PORT ST LUCIE FL
34983-3937
US

V. Phone/Fax

Practice location:
  • Phone: 772-340-7464
  • Fax: 772-785-7108
Mailing address:
  • Phone: 772-340-7464
  • Fax: 772-785-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number151076
License Number StateFL

VIII. Authorized Official

Name: JENNER DUCHEINE
Title or Position: CEO
Credential:
Phone: 772-340-7464