Provider Demographics
NPI:1619396421
Name:LIONHEART HOME HEALTHCARE
Entity Type:Organization
Organization Name:LIONHEART HOME HEALTHCARE
Other - Org Name:DANIELE HALL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-232-4905
Mailing Address - Street 1:593 W ENCHANTED DESERT DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6611
Mailing Address - Country:US
Mailing Address - Phone:775-232-4905
Mailing Address - Fax:
Practice Address - Street 1:593 W ENCHANTED DESERT DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6611
Practice Address - Country:US
Practice Address - Phone:775-232-4905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ895436Medicaid