Provider Demographics
NPI:1043072333
Name:CHILDRENS MAGICAL HEARTS LLC
Entity Type:Organization
Organization Name:CHILDRENS MAGICAL HEARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME BASED PERSONAL SUPPORT AGENCY
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:177-388-6896
Mailing Address - Street 1:7332 S EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-2320
Mailing Address - Country:US
Mailing Address - Phone:177-388-6896
Mailing Address - Fax:
Practice Address - Street 1:7332 S EMERALD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-2320
Practice Address - Country:US
Practice Address - Phone:177-388-6896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child