MEDICARE: CARING HEARTS HAVEN, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	311Z00000X	Custodial Care Facility
2	385H00000X	Respite Care
3	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1326871369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARING HEARTS HAVEN, LLC

Provider Business Mailing Address
First Line	:	10034 KINGS CROSSING DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-7619
Country	:	US
Telephone Number	:	904-380-1281
Fax Number	:

Provider Business Practice Location Address
First Line	:	10034 KINGS CROSSING DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-7619
Country	:	US
Telephone Number	:	904-380-1281
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. MERCEDES NICOLE HARDIN
Credential	:	RN
Telephone Number	:	904-380-1281

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	08/23/2024

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