Provider Demographics
NPI:1720414998
Name:HOPEWELL NURSE REGISTRY REGION 1, LLC
Entity Type:Organization
Organization Name:HOPEWELL NURSE REGISTRY REGION 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-386-5552
Mailing Address - Street 1:2121 KILLARNEY WAY STE H
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3400
Mailing Address - Country:US
Mailing Address - Phone:850-386-5552
Mailing Address - Fax:850-386-5505
Practice Address - Street 1:4476 LEGENDARY DR
Practice Address - Street 2:SUITE 204
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5375
Practice Address - Country:US
Practice Address - Phone:850-837-1870
Practice Address - Fax:850-837-1868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPEWELL HOME HEALTH CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211613251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health