Provider Demographics
NPI:1184159584
Name:HEALTHY HEARTS HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:HEALTHY HEARTS HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FOMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-536-7722
Mailing Address - Street 1:20506 RAVENSBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23803-1711
Mailing Address - Country:US
Mailing Address - Phone:804-536-7722
Mailing Address - Fax:804-203-5971
Practice Address - Street 1:20506 RAVENSBOURNE DR
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23803-1711
Practice Address - Country:US
Practice Address - Phone:804-536-7722
Practice Address - Fax:804-203-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health