Provider Demographics
NPI:1043409089
Name:SERVANT'S HEART HOMEMAKER SERVICES, LLC
Entity Type:Organization
Organization Name:SERVANT'S HEART HOMEMAKER SERVICES, LLC
Other - Org Name:SERVANT'S HEART HOMEMAKER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JO
Authorized Official - Middle Name:A
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:574-739-1776
Mailing Address - Street 1:948 W MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-2501
Mailing Address - Country:US
Mailing Address - Phone:574-739-1776
Mailing Address - Fax:574-739-1777
Practice Address - Street 1:948 W MIAMI AVE
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-2501
Practice Address - Country:US
Practice Address - Phone:574-739-1776
Practice Address - Fax:574-739-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty