Healthcare Provider Details

I. General information

NPI: 1356153092
Provider Name (Legal Business Name): PUREHEART ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 MADISON ST
CAMPBELL OH
44405-1834
US

IV. Provider business mailing address

1911 S HEIGHTS AVE
YOUNGSTOWN OH
44502-2947
US

V. Phone/Fax

Practice location:
  • Phone: 470-435-3997
  • Fax:
Mailing address:
  • Phone: 470-435-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: TYANN HODGES
Title or Position: DIRECTOR
Credential:
Phone: 470-435-3997