Provider Demographics
NPI:1932513256
Name:LOVING HEARTS PHC
Entity Type:Organization
Organization Name:LOVING HEARTS PHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:208-380-5383
Mailing Address - Street 1:66 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83286-5010
Mailing Address - Country:US
Mailing Address - Phone:208-380-5405
Mailing Address - Fax:
Practice Address - Street 1:66 S CENTER ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:ID
Practice Address - Zip Code:83286-5010
Practice Address - Country:US
Practice Address - Phone:208-380-5405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID203251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health