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General NPI Number Information
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NPI Number | 1114248226
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Entity Type | Organization
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Legal Business Name | NIRVANA HOME HEALTH CARE, LLC
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 141 SAGE BRUSH TRAIL SUITE E
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8194
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Country | US
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Telephone | 386-677-7006
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Fax | 386-677-7096
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Provider Business Mailing Address
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Address Line | 141 SAGE BRUSH TRAIL SUITE E
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8194
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Country | US
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Telephone | 386-677-7006
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Fax | 386-677-7096
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. TERESA A. RAGLAND
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Credential | RN
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Telephone | 386-362-8552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299993753
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License Number State | FL
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