Provider Demographics
NPI:1194981654
Name:HEALING HANDS OF SUWANNEE COUNTY, LLC
Entity type:Organization
Organization Name:HEALING HANDS OF SUWANNEE COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLI
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:LATREILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA 52983
Authorized Official - Phone:386-362-7727
Mailing Address - Street 1:405 11TH ST SW
Mailing Address - Street 2:SUITE A 101-A
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-3161
Mailing Address - Country:US
Mailing Address - Phone:386-362-7727
Mailing Address - Fax:
Practice Address - Street 1:405 11TH ST SW
Practice Address - Street 2:SUITE A 101-A
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3161
Practice Address - Country:US
Practice Address - Phone:386-362-7727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 52983302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization