Healthcare Provider Details

I. General information

NPI: 1225816838
Provider Name (Legal Business Name): HEARTFELT HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8416 N KNOXVILLE AVE STE B
PEORIA IL
61615-2085
US

IV. Provider business mailing address

8416 N KNOXVILLE AVE STE B
PEORIA IL
61615-2085
US

V. Phone/Fax

Practice location:
  • Phone: 309-706-5043
  • Fax:
Mailing address:
  • Phone: 309-706-5043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRITTNEY DICKEY
Title or Position: OWNER
Credential: REGISTERED NURSE
Phone: 309-706-5043