=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255192654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARING HEARTS AT WORK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2024
-----------------------------------------------------
Last Update Date | 01/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10917 SMOKEY RIDGE CT
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34711-7918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-512-1621
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10917 SMOKEY RIDGE CT
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34711-7918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-512-1621
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | MRS. DIONNE MULLINGS-WEIR
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 561-512-1621
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------