Healthcare Provider Details

I. General information

NPI: 1730623307
Provider Name (Legal Business Name): HARMONY SENIOR SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 PEARL ST
ST AUGUSTINE FL
32084-9542
US

IV. Provider business mailing address

PO BOX 754 2120 U.S 1 SOUTH SUITE 112
ST AUGUSTINE FL
32085-0754
US

V. Phone/Fax

Practice location:
  • Phone: 904-844-1467
  • Fax:
Mailing address:
  • Phone: 904-844-1467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number234434
License Number StateFL

VIII. Authorized Official

Name: TANYA BOATWRIGHT
Title or Position: OWNER
Credential:
Phone: 904-844-1467