Provider Demographics
NPI:1194853705
Name:HEARTS DESIRE LLC
Entity Type:Organization
Organization Name:HEARTS DESIRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:318-387-5765
Mailing Address - Street 1:2900 CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3714
Mailing Address - Country:US
Mailing Address - Phone:318-387-5765
Mailing Address - Fax:318-329-2936
Practice Address - Street 1:2900 CAMERON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3714
Practice Address - Country:US
Practice Address - Phone:318-387-5765
Practice Address - Fax:318-329-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10638251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1171328Medicaid
LAPCS 10638OtherDEPT. OF HEALTH & HOSP.