Provider Demographics
NPI:1760884746
Name:HEALTHY START MOMCARE NETWORK, INC.
Entity Type:Organization
Organization Name:HEALTHY START MOMCARE NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-999-6200
Mailing Address - Street 1:2002 OLD SAINT AUGUSTINE RD STE E45
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4874
Mailing Address - Country:US
Mailing Address - Phone:850-999-6200
Mailing Address - Fax:
Practice Address - Street 1:2002 OLD SAINT AUGUSTINE RD STE E45
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4874
Practice Address - Country:US
Practice Address - Phone:850-999-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011146800Medicaid
FL301530OtherTRADING PARTNER ID