Provider Demographics
NPI:1417665233
Name:1ST SERVING HEARTS HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:1ST SERVING HEARTS HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-857-8545
Mailing Address - Street 1:10635 STANDING STONE DR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-6172
Mailing Address - Country:US
Mailing Address - Phone:813-857-8545
Mailing Address - Fax:
Practice Address - Street 1:10635 STANDING STONE DR
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-6172
Practice Address - Country:US
Practice Address - Phone:813-857-8545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty