Provider Demographics
NPI:1558767608
Name:CONGRUENT HEARTS
Entity Type:Organization
Organization Name:CONGRUENT HEARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DENMARK
Authorized Official - Suffix:
Authorized Official - Credentials:HOMEHEALTH
Authorized Official - Phone:863-808-6061
Mailing Address - Street 1:1916 EMILY BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-0005
Mailing Address - Country:US
Mailing Address - Phone:863-808-6061
Mailing Address - Fax:
Practice Address - Street 1:1398 4TH ST NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2441
Practice Address - Country:US
Practice Address - Phone:863-808-6061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1103251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013839600Medicaid
FL1558767608Medicaid