Provider Demographics
NPI:1689952749
Name:HEART HOME CARE LLC
Entity Type:Organization
Organization Name:HEART HOME CARE LLC
Other - Org Name:HEART HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:904-551-3402
Mailing Address - Street 1:8824 ARLINGTON EXPY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-8006
Mailing Address - Country:US
Mailing Address - Phone:904-551-3402
Mailing Address - Fax:904-302-8055
Practice Address - Street 1:8824 ARLINGTON EXPY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-8006
Practice Address - Country:US
Practice Address - Phone:904-551-3402
Practice Address - Fax:904-302-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCS232271253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00357720Medicaid