Provider Demographics
NPI:1356096119
Name:OUR HEARTS HOME CARE & STAFFING LLC
Entity Type:Organization
Organization Name:OUR HEARTS HOME CARE & STAFFING LLC
Other - Org Name:OUR HEARTS HOME CARE & STAFFING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHEVELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:866-757-5858
Mailing Address - Street 1:235 APOLLO BEACH BLVD # 182
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2251
Mailing Address - Country:US
Mailing Address - Phone:866-757-5858
Mailing Address - Fax:
Practice Address - Street 1:216 APOLLO BEACH BLVD STE G
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2200
Practice Address - Country:US
Practice Address - Phone:866-757-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUR HEARTS HOME CARE & STAFFING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-19
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112157600Medicaid
FL30212265OtherNURSE REGISTRY
FL30212560OtherNURSE REGISTRY