Provider Demographics
NPI:1275316549
Name:PURPLE HEARTS HOME HEALTH LLC
Entity Type:Organization
Organization Name:PURPLE HEARTS HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-558-6657
Mailing Address - Street 1:8177 REAL QUIET LN
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9168
Mailing Address - Country:US
Mailing Address - Phone:614-558-6657
Mailing Address - Fax:
Practice Address - Street 1:8177 REAL QUIET LN
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9168
Practice Address - Country:US
Practice Address - Phone:614-558-6657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health