MEDICARE: HEHLLC

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	251E00000X	Home Health Agency	229797	FL

General Provider Information

NPI Number	:	1619033750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEHLLC

Provider Business Mailing Address
First Line	:	117 SOLANO CAY CIR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2242
Country	:	US
Telephone Number	:	904-543-1778
Fax Number	:	904-543-1755

Provider Business Practice Location Address
First Line	:	117 SOLANO CAY CIR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2242
Country	:	US
Telephone Number	:	904-543-1778
Fax Number	:	904-543-1755

Authorized Official
Title or Position	:	OWNER
Name	:	MS. HEIDI ELIZABETH HARE
Credential	:	RN
Telephone Number	:	904-543-1778

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	08/22/2020

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