Charlene Theresa Hartley

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

ALF10338 Issued in FL

Practice address

425 Daytona Ave
Holly Hill, FL 32117-3721

Phone

(386) 258-8291

Fax

(386) 258-8291

NPI assigned

Feb 24, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oasis Management Master Inc

  • Assisted Living Facility (Mental Illness)
  • Daytona Beach, FL
  • NPI 1134591258
  NPD (past) Authorized official

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

{
    "created_epoch": "1393200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393200000000",
    "number": "1649695974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GOODALL AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321184617",
            "telephone_number": "386-258-5562",
            "fax_number": "386-238-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 DAYTONA AVE",
            "city": "HOLLY HILL",
            "state": "FL",
            "postal_code": "321173721",
            "telephone_number": "386-258-8291",
            "fax_number": "386-258-8291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARTLEY",
        "first_name": "CHARLENE",
        "middle_name": "THERESA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-24",
        "last_updated": "2014-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "FL",
            "license": "ALF10338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142002000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Guardian Mobile Imaging
• Halifax Senior Care Inc
• Harmony First Homecare LLC
• Gretchen Lorraine Harrington
• Cynthia Jean Harris-Maddox
• Diane C Hatch, PA-C
• Krystal Shirley Haworth, LMT
• Helpmed Inc.
• Helpmed, Inc
• Heusner Social Solutions, LLC

• Community Health Worker in Holly Hill, FL
• Providers in Holly Hill, FL by specialty
• Community Health Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2014; 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.