Provider Demographics
NPI:1073172888
Name:PURE HEART IN-HOME SERVICES
Entity Type:Organization
Organization Name:PURE HEART IN-HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-200-0344
Mailing Address - Street 1:13410 PARKER COMMONS BLVD STE 105B
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1867
Mailing Address - Country:US
Mailing Address - Phone:239-200-0344
Mailing Address - Fax:
Practice Address - Street 1:13410 PARKER COMMONS BLVD STE 105B
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1867
Practice Address - Country:US
Practice Address - Phone:239-200-0344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health