Provider Demographics
NPI:1164040507
Name:THEIR HEART OUR PASSION PROVIDER SERVICES, INC
Entity Type:Organization
Organization Name:THEIR HEART OUR PASSION PROVIDER SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMIN
Authorized Official - Middle Name:CHEREE
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-612-3917
Mailing Address - Street 1:5687 COLONY PINE CIR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6245
Mailing Address - Country:US
Mailing Address - Phone:904-612-3917
Mailing Address - Fax:
Practice Address - Street 1:5687 COLONY PINE CIR N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6245
Practice Address - Country:US
Practice Address - Phone:904-612-3917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106303500Medicaid