Healthcare Provider Details

I. General information

NPI: 1184259129
Provider Name (Legal Business Name): HOUSE OF HEARTS CARES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 WINCHESTER LN
NORTH LIBERTY IA
52317-9162
US

IV. Provider business mailing address

1129 WINCHESTER LN
NORTH LIBERTY IA
52317-9162
US

V. Phone/Fax

Practice location:
  • Phone: 319-541-0973
  • Fax:
Mailing address:
  • Phone: 319-541-0973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: LAQUEASHA HAYES
Title or Position: OWNER
Credential:
Phone: 319-541-0973