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Organization

HEALTHCARE SOURCE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JOHN R GOODFELLOW (PRESIDENT)
(561) 227-1546
Entity
Organization

Contact information

Practice address
12230 FOREST HILL BLVD, SUITE 193, WELLINGTON, FL 33414-5700
(561) 227-1546
(561) 227-1547
Mailing address
12230 FOREST HILL BLVD, SUITE 193, WELLINGTON, FL 33414-5700
(561) 227-1546
(561) 227-1547

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
30211585
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
30211585
LICENSED NURSE REGISTRY
FL
Enumeration date
05/21/2014
Last updated
05/21/2014
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