NPIMap

Organization Active NPI

Caring Hearts Pediatric Extended Care Center, Inc

Doing business as Caring Hearts Pediatric Extended Care Center

  • Medically Fragile Infants and Children Day Care
  • Crestview, FL
National Provider Identifier
1164631511
Registry record updated May 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medically Fragile Infants and Children Day CareTaxonomy code 261QM3000X
License
60080985 Issued in FL
Legal business name
CARING HEARTS PEDIATRIC EXTENDED CARE CENTER, INC
Doing business as
Caring Hearts Pediatric Extended Care Center
Practice address
380 Medcrest Dr
Crestview, FL 32536
Phone
(850) 475-0555
Fax
(850) 475-0650
NPI assigned
May 22, 2007
Last updated
May 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joseph Harrelson
Title
Ceo
Phone
(850) 475-0555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medically Fragile Infants and Children Day Care 261QM3000X 60080985 FL Primary

Addresses

Primary practice location

380 Medcrest Dr
Crestview, FL 32536

Mailing address

380 Medcrest Dr
Crestview, FL 32536
Phone (850) 475-0555

Other identifiers 1

IdentifierTypeStateIssuer
113402700MedicaidFL

Other names 1

  • Caring Hearts Pediatric Extended Care Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Caring Hearts Pediatric Extended Care Center Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

380 Medcrest Dr
Crestview, FL 32536
Phone (850) 475-0555

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653436800000",
    "number": "1164631511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 MEDCREST DR",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "32536",
            "telephone_number": "850-475-0555",
            "fax_number": "850-475-0650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 MEDCREST DR",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "32536",
            "telephone_number": "850-475-0555",
            "fax_number": "850-475-0650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARING HEARTS PEDIATRIC EXTENDED CARE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A",
        "authorized_official_last_name": "HARRELSON",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-475-0555"
    },
    "taxonomies": [
        {
            "code": "261QM3000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medically Fragile Infants and Children Day Care",
            "state": "FL",
            "license": "60080985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113402700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Caring Hearts Pediatric Extended Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Caring Hearts Pediatric Extended Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.