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General NPI Number Information
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NPI Number | 1801703426
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Entity Type | Organization
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Legal Business Name | HEARTS OF GRACE LLC
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Dates
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Enumeration Date | 08/27/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 244 BARTON BLVD UNIT 307
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City | ROCKLEDGE
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State | FL
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Zip | 32955-2861
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Country | US
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Telephone | 321-745-5485
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Fax |
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Provider Business Mailing Address
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Address Line | 244 BARTON BLVD UNIT 307
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City | ROCKLEDGE
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State | FL
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Zip | 32955-2861
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Country | US
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Telephone | 321-745-5485
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | DEQUANDA NELSON
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Credential | LPN
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Telephone | 321-745-5485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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