MEDICARE: PUREST HEARTS HOME CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114511243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUREST HEARTS HOME CARE, LLC

Provider Business Mailing Address
First Line	:	2904 E HIGHWAY 98
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-5430
Country	:	US
Telephone Number	:	850-358-7491
Fax Number	:

Provider Business Practice Location Address
First Line	:	2904 E HIGHWAY 98
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-5430
Country	:	US
Telephone Number	:	850-358-7491
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BENITA HALSTEAD
Credential	:
Telephone Number	:	850-358-7491

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	03/01/2021

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Directions to “PUREST HEARTS HOME CARE, LLC ” Practice Location

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