Provider Demographics
NPI:1710651351
Name:PURPLE HEART SERVICES, LLC
Entity Type:Organization
Organization Name:PURPLE HEART SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:RICHARDSON HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-532-8059
Mailing Address - Street 1:2333 CANEY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-9080
Mailing Address - Country:US
Mailing Address - Phone:904-532-8059
Mailing Address - Fax:866-307-8444
Practice Address - Street 1:2333 CANEY OAKS DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-9080
Practice Address - Country:US
Practice Address - Phone:904-532-8059
Practice Address - Fax:866-307-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty