Provider Demographics
NPI:1295900231
Name:AWESOME HANDS HEALTH SERVICE
Entity type:Organization
Organization Name:AWESOME HANDS HEALTH SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:BOYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-747-0999
Mailing Address - Street 1:522 9TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-2048
Mailing Address - Country:US
Mailing Address - Phone:941-747-0999
Mailing Address - Fax:941-747-7839
Practice Address - Street 1:522 9TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-2048
Practice Address - Country:US
Practice Address - Phone:941-747-0999
Practice Address - Fax:941-747-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230507305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL230507Medicaid