Provider Demographics
NPI:1376107185
Name:ONE WORLD THREE HEARTS LLC
Entity Type:Organization
Organization Name:ONE WORLD THREE HEARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:JOHNSON-IVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-217-4209
Mailing Address - Street 1:2769 PLUMBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-7727
Mailing Address - Country:US
Mailing Address - Phone:321-525-3221
Mailing Address - Fax:
Practice Address - Street 1:2769 PLUMBERRY AVE
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-7727
Practice Address - Country:US
Practice Address - Phone:321-525-3221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101791100Medicaid