Provider Demographics
NPI:1932868353
Name:PEDIATRIC VILLAGE HOME CARE LLC
Entity Type:Organization
Organization Name:PEDIATRIC VILLAGE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OTR/L
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:TWEEDIE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:773-592-4444
Mailing Address - Street 1:19765 CHICORY AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3362
Mailing Address - Country:US
Mailing Address - Phone:541-904-0166
Mailing Address - Fax:541-312-6240
Practice Address - Street 1:19765 CHICORY AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3362
Practice Address - Country:US
Practice Address - Phone:541-904-0166
Practice Address - Fax:541-312-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty