Provider Demographics
NPI:1003402256
Name:HEALING HEARTS HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:HEALING HEARTS HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KOTIONA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-206-0834
Mailing Address - Street 1:349 WESTMONT DR
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1023
Mailing Address - Country:US
Mailing Address - Phone:610-583-2320
Mailing Address - Fax:
Practice Address - Street 1:349 WESTMONT DR
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1023
Practice Address - Country:US
Practice Address - Phone:610-583-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health