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General NPI Number Information
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NPI Number | 1487821807
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Entity Type | Organization
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Legal Business Name | HEART OF FLORIDA CARE INC.
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 301 S 10TH ST
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City | HAINES CITY
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State | FL
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Zip | 33844-5601
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Country | US
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Telephone | 863-421-2982
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S 10TH ST
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City | HAINES CITY
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State | FL
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Zip | 33844-5601
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Country | US
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Telephone | 863-421-2982
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. JAS LALLY
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Credential |
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Telephone | 863-421-2982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | AL9965
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License Number State | FL
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