Healthcare Provider Details

I. General information

NPI: 1700525631
Provider Name (Legal Business Name): OUR HEARTS HOME CARE & STAFFING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2822 54TH AVE S # 150
ST PETERSBURG FL
33712-4610
US

IV. Provider business mailing address

235 APOLLO BEACH BLVD # 182
APOLLO BEACH FL
33572-2251
US

V. Phone/Fax

Practice location:
  • Phone: 866-757-5858
  • Fax: 866-757-5858
Mailing address:
  • Phone: 813-603-3096
  • Fax: 866-757-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHEVELLE R JORDAN
Title or Position: CEO
Credential: REGISTERED NURSE
Phone: 727-674-1800