Healthcare Provider Details

I. General information

NPI: 1134984461
Provider Name (Legal Business Name): HOUSE OF HEARTS II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 W 144TH ST
RIVERDALE IL
60827-2615
US

IV. Provider business mailing address

4731 MIDLOTHIAN TPKE STE 32
CRESTWOOD IL
60418-1990
US

V. Phone/Fax

Practice location:
  • Phone: 708-880-1110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN SARDIN
Title or Position: MANAGER
Credential:
Phone: 773-499-4062