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General NPI Number Information
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NPI Number | 1598286619
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Entity Type | Organization
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Legal Business Name | HEADS
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1001 E BAKER ST
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City | PLANT CITY
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State | FL
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Zip | 33563-3700
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Country | US
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Telephone | 918-521-8501
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 JACOB WAY
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City | ODESSA
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State | FL
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Zip | 33556-6035
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUDY WALLER
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Credential |
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Telephone | 813-495-3874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | FL
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