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General NPI Number Information
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NPI Number | 1528384989
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Entity Type | Organization
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Legal Business Name | HOGANS HARVEST INC
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Dates
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Enumeration Date | 04/09/2010
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 4752 AVENUE D
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-5228
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Country | US
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Telephone | 904-377-6845
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Fax | 904-429-7526
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Provider Business Mailing Address
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Address Line | 99 KING ST
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-4343
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Country | US
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Telephone | 904-377-6845
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Fax | 904-429-7526
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | DR. CHERYL DELORES HOGAN
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Credential |
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Telephone | 904-377-6845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 692535996
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License Number State | FL
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