Provider Demographics
NPI:1871519843
Name:QUALITY OF LIFE HOMECARE OF HERNANDO, INC.
Entity type:Organization
Organization Name:QUALITY OF LIFE HOMECARE OF HERNANDO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-546-9692
Mailing Address - Street 1:7235 BRYAN DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1538
Mailing Address - Country:US
Mailing Address - Phone:727-546-9692
Mailing Address - Fax:727-547-0942
Practice Address - Street 1:307 HOWELL AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2039
Practice Address - Country:US
Practice Address - Phone:352-754-2818
Practice Address - Fax:352-754-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108235Medicare ID - Type UnspecifiedMEDICARE HOME HEALTH PROV