Healthcare Provider Details

I. General information

NPI: 1760192660
Provider Name (Legal Business Name): HEARTFELT HOME AIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/10/2022
Certification Date: 12/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 WILLOW CREEK DR
MIDWEST CITY OK
73110-7220
US

IV. Provider business mailing address

3425 WILLOW CREEK DR
MIDWEST CITY OK
73110-7220
US

V. Phone/Fax

Practice location:
  • Phone: 405-512-3330
  • Fax:
Mailing address:
  • Phone: 405-512-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SERENITI IRISH
Title or Position: VICE PRESIDENT
Credential:
Phone: 405-240-8507