Healthcare Provider Details

I. General information

NPI: 1629105895
Provider Name (Legal Business Name): HEARTS DESIRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
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 TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number10638
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

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