Provider Demographics
NPI:1780291013
Name:PURPLE HEART HEALTH CARE, INC.
Entity type:Organization
Organization Name:PURPLE HEART HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR/FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-554-1341
Mailing Address - Street 1:PO BOX 988
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-0988
Mailing Address - Country:US
Mailing Address - Phone:407-554-1341
Mailing Address - Fax:407-554-1349
Practice Address - Street 1:1202 E SILVER STAR RD STE B
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2460
Practice Address - Country:US
Practice Address - Phone:407-554-1341
Practice Address - Fax:407-554-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1007076OtherAVAILITY
FL299995035OtherAHCA - AGENCY FOR HEALTH CARE ADMINISTRATION
FL14977433OtherCAQH