Provider Demographics
NPI:1902260680
Name:SPECIAL HEARTS SUPPORTS & SERVICES, LLC
Entity Type:Organization
Organization Name:SPECIAL HEARTS SUPPORTS & SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-415-5906
Mailing Address - Street 1:4758 PLAYPEN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1421
Mailing Address - Country:US
Mailing Address - Phone:904-415-5906
Mailing Address - Fax:904-212-2283
Practice Address - Street 1:4758 PLAYPEN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1421
Practice Address - Country:US
Practice Address - Phone:904-415-5906
Practice Address - Fax:904-212-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL015352000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health