Provider Demographics
NPI:1891150579
Name:HEALTHY HEARTS HOME CARE LLC
Entity Type:Organization
Organization Name:HEALTHY HEARTS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAVERENE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DELUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-256-2588
Mailing Address - Street 1:1830 PORTER WAGONER BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1810
Mailing Address - Country:US
Mailing Address - Phone:417-256-2588
Mailing Address - Fax:417-256-2533
Practice Address - Street 1:1830 PORTER WAGONER BLVD
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1810
Practice Address - Country:US
Practice Address - Phone:417-256-2588
Practice Address - Fax:417-256-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001465846251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services