=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699269605
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HHNS, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2018
-----------------------------------------------------
Last Update Date | 06/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1948 E EDGEWOOD DR
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33803-3471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-616-1888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1948 E EDGEWOOD DR
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33803-3471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-616-1888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEALTH INFORMATION MANAGER
-----------------------------------------------------
Name | MR. JUSTIN GOLD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 863-616-1888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | 30211268
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------