=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124602487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANDS OF GLORY HOMECARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2021
-----------------------------------------------------
Last Update Date | 05/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2102 W COCO CT APT P5
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33604-7612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-431-8553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2102 W COCO CT APT P5
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33604-7612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-431-8553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHARAIN HICKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-431-8553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------