Organization
MAHONEY'S HEART
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES POTTS MD (MEDICAL DIRECTOR)
(606) 585-5448
Entity
Organization
Contact information
Practice address
304 BROYLES DR SE, PALM BAY, FL 32909-2353
(727) 846-2469
Mailing address
304 BROYLES DR SE, PALM BAY, FL 32909-2353
(727) 846-2469
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
—
—
163WG0000X
General Practice Registered Nurse
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251F00000X
Home Infusion Agency
—
—
251J00000X
Nursing Care Agency
—
—
251T00000X
PACE Provider Organization
—
—
253Z00000X
In Home Supportive Care Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
06/12/2023
Last updated
06/12/2023
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