Provider Demographics
NPI:1184236929
Name:MOORE'S HEART HOMECARE LLC
Entity type:Organization
Organization Name:MOORE'S HEART HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LATTIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:HOME HEALTH AIDE
Authorized Official - Phone:863-732-0319
Mailing Address - Street 1:2401 2ND ST NW
Mailing Address - Street 2:#52
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4941
Mailing Address - Country:US
Mailing Address - Phone:863-732-0319
Mailing Address - Fax:
Practice Address - Street 1:2401 2ND ST NW
Practice Address - Street 2:#52
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4941
Practice Address - Country:US
Practice Address - Phone:863-732-0319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-22
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107746400Medicaid