MEDICARE: OUR HEARTS YOUR HOME 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	:	1982394862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR HEARTS YOUR HOME LLC

Provider Business Mailing Address
First Line	:	14573 CHRISTEN DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-0827
Country	:	US
Telephone Number	:	904-422-1345
Fax Number	:

Provider Business Practice Location Address
First Line	:	4840 HATTERAS RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-1853
Country	:	US
Telephone Number	:	904-422-1345
Fax Number	:	904-439-7613

Authorized Official
Title or Position	:	OWNER
Name	:	IMAN HALL
Credential	:	RN
Telephone Number	:	904-422-1345

Provider Enumeration Date	:	05/12/2023
Last Update Date	:	05/12/2023

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Directions to “OUR HEARTS YOUR HOME LLC ” Practice Location

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