MEDICARE: HARVESTREAPERSINTL CHAPLAIN ASSOCIATION

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	405300000X	Prevention Professional	00000000001111	GA

General Provider Information

NPI Number	:	1386130003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARVESTREAPERSINTL CHAPLAIN ASSOCIATION

Provider Business Mailing Address
First Line	:	5460 N STATE ROAD 7 STE 122
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33319-2968
Country	:	US
Telephone Number	:	786-525-7669
Fax Number	:

Provider Business Practice Location Address
First Line	:	5460 N STATE ROAD 7 STE 122
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33319-2968
Country	:	US
Telephone Number	:	786-525-7669
Fax Number	:

Authorized Official
Title or Position	:	CHAPLAIN
Name	:	GLORIA SPENCE
Credential	:	COUNSELOR
Telephone Number	:	754-422-4200

Provider Enumeration Date	:	07/05/2018
Last Update Date	:	07/05/2018

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