MEDICARE: NEVAEH PURE HEART SERVICES, 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1568316032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVAEH PURE HEART SERVICES, LLC

Provider Business Mailing Address
First Line	:	225 DUVAL STATION RD UNIT 333
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-1973
Country	:	US
Telephone Number	:	904-888-7988
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 DUVAL STATION RD UNIT 333
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-1973
Country	:	US
Telephone Number	:	904-888-7988
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SHERDINA COOPER
Credential	:
Telephone Number	:	904-888-7988

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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