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General NPI Number Information
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NPI Number | 1033732268
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Entity Type | Organization
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Legal Business Name | HEARTS FOR COMPANION LLC
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 1310 PETERS DR
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City | LEESBURG
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State | FL
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Zip | 34748-4041
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Country | US
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Telephone | 352-408-4924
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 PETERS DR
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City | LEESBURG
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State | FL
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Zip | 34748-4041
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEIONTAYE TOLBERT
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Credential |
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Telephone | 352-408-4924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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