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NPI Code Detail

MEDICARE: HIDDEN POTENTIALS INC.

MEDICARE: HIDDEN POTENTIALS 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
13747P1801XPersonal Care Attendant

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649404567
Entity Type Code : Organization
Provider Name (Legal Business Name) : HIDDEN POTENTIALS INC.
Provider Business Mailing Address
First Line : 5650 S WASHINGTON AVE
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-7312
Country : US
Telephone Number : 321-267-6318
Fax Number : 321-267-1194
Provider Business Practice Location Address
First Line : 5650 S WASHINGTON AVE
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-7312
Country : US
Telephone Number : 321-267-6318
Fax Number : 321-267-1194
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MRS. KATHY CLINTON
Credential :
Telephone Number : 321-267-6318
Provider Enumeration Date : 05/06/2009
Last Update Date : 05/06/2009

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