Provider Demographics
NPI:1023344751
Name:HEART AND SOUL HOME HEALTH PROVIDER
Entity type:Organization
Organization Name:HEART AND SOUL HOME HEALTH PROVIDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-830-5300
Mailing Address - Street 1:22345 GLENFORD DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-9083
Mailing Address - Country:US
Mailing Address - Phone:574-830-5300
Mailing Address - Fax:574-830-5300
Practice Address - Street 1:22345 GLENFORD DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-9083
Practice Address - Country:US
Practice Address - Phone:574-830-5300
Practice Address - Fax:574-830-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-31
Last Update Date:2009-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health