Healthcare Provider Details

I. General information

NPI: 1821936634
Provider Name (Legal Business Name): A NANIE'S HEART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 ESTRELLA ST
RANCHO MIRAGE CA
92270-3949
US

IV. Provider business mailing address

106 ESTRELLA ST
RANCHO MIRAGE CA
92270-3949
US

V. Phone/Fax

Practice location:
  • Phone: 760-324-4679
  • Fax:
Mailing address:
  • Phone: 760-324-4679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: BETH JACKSON
Title or Position: LICENSEE
Credential:
Phone: 858-829-4486