Provider Demographics
NPI:1700525631
Name:OUR HEARTS HOME CARE & STAFFING LLC
Entity Type:Organization
Organization Name:OUR HEARTS HOME CARE & STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHEVELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:727-674-1800
Mailing Address - Street 1:235 APOLLO BEACH BLVD # 182
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2251
Mailing Address - Country:US
Mailing Address - Phone:813-603-3096
Mailing Address - Fax:866-757-5858
Practice Address - Street 1:2822 54TH AVE S # 150
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-4610
Practice Address - Country:US
Practice Address - Phone:866-757-5858
Practice Address - Fax:866-757-5858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUR HEARTS HOME CARE & STAFFING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL237242OtherAHCA LICENSE - PASCO, PINELLAS
FL108510800Medicaid