Provider Demographics
NPI:1639526908
Name:HEART, BODY & MIND HEALTHCARE
Entity Type:Organization
Organization Name:HEART, BODY & MIND HEALTHCARE
Other - Org Name:HEART, BODY & MIND HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-603-6455
Mailing Address - Street 1:12670 WORLD PLAZA LN
Mailing Address - Street 2:BLDG. 62, SUITE 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4074
Mailing Address - Country:US
Mailing Address - Phone:239-603-6455
Mailing Address - Fax:
Practice Address - Street 1:12670 WORLD PLAZA LN
Practice Address - Street 2:BLDG. 62, SUITE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4074
Practice Address - Country:US
Practice Address - Phone:239-603-6455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994472251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health