Provider Demographics
NPI:1528384989
Name:HOGANS HARVEST INC
Entity Type:Organization
Organization Name:HOGANS HARVEST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:DELORES
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-377-6845
Mailing Address - Street 1:99 KING ST
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4343
Mailing Address - Country:US
Mailing Address - Phone:904-377-6845
Mailing Address - Fax:904-429-7526
Practice Address - Street 1:4752 AVENUE D
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-5228
Practice Address - Country:US
Practice Address - Phone:904-377-6845
Practice Address - Fax:904-429-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL692535996251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692535996Medicaid