MEDICARE: HEART OF MINE HOME CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1932709581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART OF MINE HOME CARE, LLC

Provider Business Mailing Address
First Line	:	1925 KEITH RD UNIT 9
Second Line	:
City	:	ABINGTON
State	:	PA
Zip	:	19001-2628
Country	:	US
Telephone Number	:	215-237-6439
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521 66TH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-2766
Country	:	US
Telephone Number	:	215-237-6439
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. TAHIRA VERNICE WILSON
Credential	:	RN
Telephone Number	:	215-237-6439

Provider Enumeration Date	:	10/31/2020
Last Update Date	:	10/31/2020

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