Provider Demographics
NPI:1689092504
Name:HOPEWELL NURSE REGISTRY, LLC
Entity Type:Organization
Organization Name:HOPEWELL NURSE REGISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HAYWARD
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:850-386-5552
Mailing Address - Street 1:2121 KILLARNEY WAY
Mailing Address - Street 2:SUITE H
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3458
Mailing Address - Country:US
Mailing Address - Phone:850-386-5552
Mailing Address - Fax:850-386-5505
Practice Address - Street 1:2121 KILLARNEY WAY
Practice Address - Street 2:SUITE H
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3458
Practice Address - Country:US
Practice Address - Phone:850-386-5552
Practice Address - Fax:850-386-5505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPEWELL HOME HEALTH CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211090251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health