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General NPI Number Information
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NPI Number | 1437640653
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Entity Type | Organization
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Legal Business Name | HANNAH'S HOME LLC
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 997 LYONS CIR NW
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City | PALM BAY
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State | FL
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Zip | 32907-5911
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Country | US
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Telephone | 954-993-0244
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Fax |
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Provider Business Mailing Address
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Address Line | 997 LYONS CIR NW
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City | PALM BAY
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State | FL
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Zip | 32907-5911
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Country | US
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Telephone | 954-993-0244
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MR. KYLE LIGHTBOURNE
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Credential |
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Telephone | 954-993-0244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12037
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License Number State | FL
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