MEDICARE: INSPIRED HEARTS AGENCY INC

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	261QD1600X	Developmental Disabilities Clinic/Center

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	:	1174115844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSPIRED HEARTS AGENCY INC

Provider Business Mailing Address
First Line	:	2627 SILVER HILLS DR APT 5
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-5797
Country	:	US
Telephone Number	:	407-692-8460
Fax Number	:

Provider Business Practice Location Address
First Line	:	2627 SILVER HILLS DR APT 5
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-5797
Country	:	US
Telephone Number	:	407-692-8460
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANGELITA PATTERSON- HALL
Credential	:
Telephone Number	:	772-283-6757

Provider Enumeration Date	:	02/04/2021
Last Update Date	:	02/04/2021

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