Provider Demographics
NPI:1942487046
Name:YVONNE R HALL
Entity Type:Organization
Organization Name:YVONNE R HALL
Other - Org Name:HEARTS THAT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-438-9242
Mailing Address - Street 1:523 EASTLAKE CLUB DR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2472
Mailing Address - Country:US
Mailing Address - Phone:352-438-9242
Mailing Address - Fax:727-772-5675
Practice Address - Street 1:523 EASTLAKE CLUB DR
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-2472
Practice Address - Country:US
Practice Address - Phone:352-438-9242
Practice Address - Fax:727-772-5675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251S00000X, 311ZA0620X, 385H00000X
FL693593100253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693593102Medicaid
FL693593100Medicaid
FL693593101Medicaid