Organization
TAKITA S. HAYES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAKITA HAYES (OWNER)
(352) 504-8964
Entity
Organization
Contact information
Practice address
5024 GRASSY KNOLL DR, TAVARES, FL 32778-6211
(352) 504-8964
Mailing address
5024 GRASSY KNOLL DR, TAVARES, FL 32778-6211
(352) 504-8964
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
FL
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029624--
—
FL
05
—
102962400
—
FL
Enumeration date
07/10/2007
Last updated
07/21/2022
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