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General NPI Number Information
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NPI Number | 1174139059
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Entity Type | Organization
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Legal Business Name | HEARTLY SENIOR CARE SERVICES LLC
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 3625 STATE ROAD 419 STE 110
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-2672
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Country | US
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Telephone | 850-405-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 9300 CONROY WINDERMERE RD
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City | WINDERMERE
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State | FL
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Zip | 34786-5000
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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 | OWNER
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Name | SANIECIA DAVIS
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Credential |
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Telephone | 850-405-2240
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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 |
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License Number State |
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