Provider Demographics
NPI:1558780882
Name:HEARTS HOME CARE LLC
Entity Type:Organization
Organization Name:HEARTS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:TAKPO
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-288-9921
Mailing Address - Street 1:625 SNELLING AVE
Mailing Address - Street 2:UNIT A, #1
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-493-4353
Mailing Address - Fax:866-807-7293
Practice Address - Street 1:625 SNELLING AVE
Practice Address - Street 2:UNIT A, #1
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-493-4353
Practice Address - Fax:866-807-7293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN365718251E00000X
364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Single Specialty
No251E00000XAgenciesHome Health