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Individual

MS. BERTILDA ISABEL HARVEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
913 LEE ST, LEESBURG, FL 34748-4310
(352) 874-5646
(352) 326-8177
Mailing address
913 LEE ST, LEESBURG, FL 34748-4310
(352) 874-5646
(352) 326-8177

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
676209368
MEDICAID WAIVER - CONSUMER DIRECTED CARE PLUS
01
676209396
MEDICAID WAIVER - HOME AND COMMUNITY BASED SERVICES.
FL
01
676209398
MEDICAID WAIVER - FAMILY SUPPORTED LIVING WAIVER
Enumeration date
01/20/2011
Last updated
01/20/2011
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