Provider Demographics
NPI:1790094019
Name:HIDDEND PEARLS LLC
Entity Type:Organization
Organization Name:HIDDEND PEARLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOODEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:330-418-1025
Mailing Address - Street 1:1012 S. LIBERTY AVE.
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4062
Mailing Address - Country:US
Mailing Address - Phone:330-821-3702
Mailing Address - Fax:330-821-3708
Practice Address - Street 1:1012 S. LIBERTY AVE.
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4062
Practice Address - Country:US
Practice Address - Phone:330-418-1025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103TM1800X, 251B00000X, 251E00000X, 252Y00000X, 253Z00000X, 347B00000X, 347C00000X
261QD1600X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347B00000XTransportation ServicesBus
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3013689Medicaid