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General NPI Number Information
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NPI Number | 1164631511
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Entity Type | Organization
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Legal Business Name | CARING HEARTS PEDIATRIC EXTENDED CARE CENTER, INC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 380 MEDCREST DR
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City | CRESTVIEW
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State | FL
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Zip | 32536
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Country | US
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Telephone | 850-475-0555
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Fax | 850-475-0650
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Provider Business Mailing Address
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Address Line | 380 MEDCREST DR
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City | CRESTVIEW
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State | FL
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Zip | 32536
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Country | US
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Telephone | 850-475-0555
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Fax | 850-475-0650
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Authorized Official
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Title or Position | CEO
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Name | JOSEPH HARRELSON
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Credential |
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Telephone | 850-475-0555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM3000X
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Taxonomy Name | Medically Fragile Infants and Children Day Care
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License Number | 60080985
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License Number State | FL
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