Provider Demographics
NPI:1568074946
Name:JERRY HEALING HANDS INC
Entity Type:Organization
Organization Name:JERRY HEALING HANDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KETTLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STCYR
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-262-7450
Mailing Address - Street 1:5700 LAKE WORTH RD STE 209
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5700 LAKE WORTH RD STE 209
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4727
Practice Address - Country:US
Practice Address - Phone:786-262-7450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service