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General NPI Number Information
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NPI Number | 1558086629
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Entity Type | Organization
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Legal Business Name | HEART OF CARRIE LLC
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 17 OLD KINGS RD N STE E
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City | PALM COAST
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State | FL
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Zip | 32137-8283
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Country | US
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Telephone | 386-585-4406
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Fax |
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Provider Business Mailing Address
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Address Line | 17 OLD KINGS RD N STE E
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City | PALM COAST
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State | FL
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Zip | 32137-8283
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Country | US
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Telephone | 386-585-4406
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANITA DIONNE JACKSON
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Credential |
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Telephone | 386-264-1398
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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 |
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License Number State |
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