Healthcare Provider Details

I. General information

NPI: 1013373117
Provider Name (Legal Business Name): HEART TO HOME INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 PAGEL RD
MENDOTA HEIGHTS MN
55120-1638
US

IV. Provider business mailing address

659 FREEWAY RD S
MENDOTA HEIGHTS MN
55118-4314
US

V. Phone/Fax

Practice location:
  • Phone: 651-994-2020
  • Fax: 651-686-5295
Mailing address:
  • Phone: 651-485-8738
  • Fax: 651-686-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number25755
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number25755
License Number StateMN

VIII. Authorized Official

Name: JOSHUA WILLIAM CESARO-MOXLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 651-485-8738