Provider Demographics
NPI:1891702676
Name:FROM THE HEART MEDWAIVER PROVIDER, INC
Entity Type:Organization
Organization Name:FROM THE HEART MEDWAIVER PROVIDER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-764-3127
Mailing Address - Street 1:3001 PERCY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-2325
Mailing Address - Country:US
Mailing Address - Phone:904-764-3127
Mailing Address - Fax:904-764-2659
Practice Address - Street 1:3001 PERCY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2325
Practice Address - Country:US
Practice Address - Phone:904-764-3127
Practice Address - Fax:904-764-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services