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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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