Provider Demographics
NPI:1770101859
Name:HUMBLE HEARTS OF CENTRAL FLORIDA LLC
Entity type:Organization
Organization Name:HUMBLE HEARTS OF CENTRAL FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAT
Authorized Official - Middle Name:ABAD
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-396-5416
Mailing Address - Street 1:11509 PINELOCH LOOP
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6459
Mailing Address - Country:US
Mailing Address - Phone:352-396-5416
Mailing Address - Fax:
Practice Address - Street 1:11509 PINELOCH LOOP
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6459
Practice Address - Country:US
Practice Address - Phone:352-396-5416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities