Healthcare Provider Details

I. General information

NPI: 1861168205
Provider Name (Legal Business Name): GLOWING HEARTS HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 BROAD ST FL 2
NEWARK NJ
07102-4503
US

IV. Provider business mailing address

PO BOX 9506
NEWARK NJ
07104-0506
US

V. Phone/Fax

Practice location:
  • Phone: 973-318-8316
  • Fax: 973-318-8317
Mailing address:
  • Phone: 862-323-3502
  • Fax: 973-318-8317

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: LESLIEANN PETERSON
Title or Position: CEO
Credential:
Phone: 862-323-3502