Provider Demographics
NPI:1972218881
Name:HAPPYFEET PERSONAL CARE
Entity Type:Organization
Organization Name:HAPPYFEET PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-278-5888
Mailing Address - Street 1:1106 THOMASVILLE RD STE J
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6276
Mailing Address - Country:US
Mailing Address - Phone:850-273-5888
Mailing Address - Fax:850-807-5060
Practice Address - Street 1:1106 THOMASVILLE RD STE J
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6276
Practice Address - Country:US
Practice Address - Phone:850-273-5888
Practice Address - Fax:850-807-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104625Medicaid