Provider Demographics
NPI:1811306368
Name:AUTISM HOME HEALTH MOMS
Entity type:Organization
Organization Name:AUTISM HOME HEALTH MOMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARENT
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RICARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-924-5773
Mailing Address - Street 1:798 SW BELMONT CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6338
Mailing Address - Country:US
Mailing Address - Phone:772-924-5773
Mailing Address - Fax:
Practice Address - Street 1:798 SW BELMONT CIR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6338
Practice Address - Country:US
Practice Address - Phone:772-924-5773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Single Specialty