Organization
HEART OF FLORIDA CARE INC.
Active
Other names
Hampton Court
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAS LALLY (VICE PRESIDENT)
(863) 421-2982
Entity
Organization
Contact information
Practice address
301 S 10TH ST, HAINES CITY, FL 33844-5601
(863) 421-2982
Mailing address
301 S 10TH ST, HAINES CITY, FL 33844-5601
(863) 421-2982
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
AL9965
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11194301
MEDICAID DIVERSION PROVIDER #
FL
05
—
140884400
—
FL
01
—
284871
DIVERSION PROVIDER #
FL
01
—
6000793
MEDICAID DIVERSION PROVIDER #
FL
05
—
683660700
—
FL
Enumeration date
05/14/2008
Last updated
05/14/2008
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