Healthcare Provider Details

I. General information

NPI: 1720625478
Provider Name (Legal Business Name): LOVING HOUSE OF HEARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 WINCHESTER LANE
NORTH LIBERTY IA
52317
US

IV. Provider business mailing address

1129 WINCHESTER LANE
NORTH LIBERTY IA
52317
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 Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

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