Healthcare Provider Details

I. General information

NPI: 1932709581
Provider Name (Legal Business Name): HEART OF MINE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2020
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 66TH AVE
PHILADELPHIA PA
19126-2766
US

IV. Provider business mailing address

1925 KEITH RD UNIT 9
ABINGTON PA
19001-2628
US

V. Phone/Fax

Practice location:
  • Phone: 215-237-6439
  • Fax:
Mailing address:
  • Phone: 215-237-6439
  • Fax:

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: MS. TAHIRA VERNICE WILSON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 215-237-6439