Healthcare Provider Details

I. General information

NPI: 1003399411
Provider Name (Legal Business Name): VISITING HEARTS HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 N CENTRAL AVE # 945
PHOENIX AZ
85012-1906
US

IV. Provider business mailing address

3355 N WHITE AVE UNIT 381
LA VERNE CA
91750-6117
US

V. Phone/Fax

Practice location:
  • Phone: 623-220-9118
  • Fax:
Mailing address:
  • Phone: 310-927-8751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SUZETTE JOHNSON
Title or Position: CEO
Credential:
Phone: 310-927-8751