Provider Demographics
NPI:1780846568
Name:HEART TO HEART PROVIDER LLC
Entity Type:Organization
Organization Name:HEART TO HEART PROVIDER LLC
Other - Org Name:HEART TO HEART PROVIDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-684-2351
Mailing Address - Street 1:3836 MORNING SPRINGS TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-5014
Mailing Address - Country:US
Mailing Address - Phone:469-684-2351
Mailing Address - Fax:702-446-5164
Practice Address - Street 1:3836 MORNING SPRINGS TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-5014
Practice Address - Country:US
Practice Address - Phone:469-684-2351
Practice Address - Fax:702-446-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)