Basic Information
| Provider Information | |||||||||
| NPI: | 1205957479 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HERNANDO HEALTH CARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7235 BRYAN DAIRY RD | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337771538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275469692 | ||||||||
| FaxNumber: | 7275470942 | ||||||||
| Practice Location | |||||||||
| Address1: | 307 HOWELL AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346012039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527963276 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HEENAN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7275469692 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 7622 | FL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.