Healthcare Provider Details

I. General information

NPI: 1336796176
Provider Name (Legal Business Name): HEAVEN TO EARTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8406 US HIGHWAY 301 N
TAMPA FL
33637-6789
US

IV. Provider business mailing address

8406 US HIGHWAY 301 N
TAMPA FL
33637-6789
US

V. Phone/Fax

Practice location:
  • Phone: 229-630-9040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LATOYA GOLDEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 229-630-9040