Healthcare Provider Details

I. General information

NPI: 1528903903
Provider Name (Legal Business Name): TENDER HEARTS HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 W RACHAEL CT
PEORIA IL
61615-3062
US

IV. Provider business mailing address

5710 W RACHAEL CT
PEORIA IL
61615-3062
US

V. Phone/Fax

Practice location:
  • Phone: 717-802-4493
  • Fax:
Mailing address:
  • Phone: 717-802-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NINA KOBOLON-NGAUSS
Title or Position: RN
Credential: KOBOLON-NGAUSS
Phone: 717-802-4493