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General NPI Number Information
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NPI Number | 1629582440
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Entity Type | Organization
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Legal Business Name | FOUR HEARTS
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Dates
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Enumeration Date | 12/01/2017
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 462 W 14TH ST
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City | RIVIERA BEACH
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State | FL
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Zip | 33404
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Country | US
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Telephone | 561-876-1541
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10452
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City | RIVIERA BEACH
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State | FL
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Zip | 33419-0452
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Country | US
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Telephone | 561-876-1541
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. JEWEL ELOIS MCDONALD
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Credential |
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Telephone | 561-876-1541
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 234977
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License Number State | FL
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