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General NPI Number Information
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NPI Number | 1245697168
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Entity Type | Organization
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Legal Business Name | HATTIE MORGAN HOUSE LLC
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 637 KISSIMMEE ST
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City | TALLAHASSEE
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State | FL
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Zip | 32310-5410
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Country | US
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Telephone | 850-716-5628
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Fax |
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Provider Business Mailing Address
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Address Line | 637 KISSIMMEE ST
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City | TALLAHASSEE
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State | FL
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Zip | 32310-5410
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Country | US
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Telephone | 850-716-5628
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KERUSHEL A ROLLINS
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Credential |
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Telephone | 850-716-5628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | FL
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