Provider Demographics
NPI:1891563607
Name:HEART OF RESILIENCE HOMECARE
Entity Type:Organization
Organization Name:HEART OF RESILIENCE HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANELL
Authorized Official - Middle Name:VONTRES
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-535-8954
Mailing Address - Street 1:237 ST GEORGES CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33839-5211
Mailing Address - Country:US
Mailing Address - Phone:863-535-8954
Mailing Address - Fax:
Practice Address - Street 1:237 ST GEORGES CIR
Practice Address - Street 2:
Practice Address - City:EAGLE LAKE
Practice Address - State:FL
Practice Address - Zip Code:33839-5211
Practice Address - Country:US
Practice Address - Phone:863-535-8954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health