=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356141808
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE HARTAGE FOUNDATION INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2025
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1405 S ORANGE AVE STE 324
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-2129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-820-5750
-----------------------------------------------------
Fax | 407-820-5750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 560245
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32856-0245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-221-4435
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HOMER L HARTAGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-221-4351
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------