Healthcare Provider Details

I. General information

NPI: 1194853705
Provider Name (Legal Business Name): HEARTS DESIRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CAMERON ST
MONROE LA
71201-3714
US

IV. Provider business mailing address

2900 CAMERON ST
MONROE LA
71201-3714
US

V. Phone/Fax

Practice location:
  • Phone: 318-387-5765
  • Fax: 318-329-2936
Mailing address:
  • Phone: 318-387-5765
  • Fax: 318-329-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number10638
License Number StateLA

VIII. Authorized Official

Name: MR. WILLIAM G. WORLEY JR.
Title or Position: CO-OWNER
Credential:
Phone: 318-387-5765