Healthcare Provider Details

I. General information

NPI: 1508529009
Provider Name (Legal Business Name): HEART OF HOPE HOMECARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MAIN ST
JACKSBORO TN
37757-2964
US

IV. Provider business mailing address

297 MOUNTAIN VIEW EST
CARYVILLE TN
37714-3539
US

V. Phone/Fax

Practice location:
  • Phone: 865-382-2964
  • Fax:
Mailing address:
  • Phone:
  • Fax: 423-374-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: REBECCA PETERSON
Title or Position: OWNER
Credential: LPN
Phone: 865-382-2964