Provider Demographics
NPI:1770963019
Name:LADY SPEARHEAD, LLC
Entity type:Organization
Organization Name:LADY SPEARHEAD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGDAJEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-834-2474
Mailing Address - Street 1:10033 SAWGRASS DR W
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10033 SAWGRASS DR W
Practice Address - Street 2:SUITE 209
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3564
Practice Address - Country:US
Practice Address - Phone:904-834-2474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233379305R00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No305R00000XManaged Care OrganizationsPreferred Provider Organization