Healthcare Provider Details

I. General information

NPI: 1780846568
Provider Name (Legal Business Name): HEART TO HEART PROVIDER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3836 MORNING SPRINGS TRL
DALLAS TX
75224-5014
US

IV. Provider business mailing address

3836 MORNING SPRINGS TRL
DALLAS TX
75224-5014
US

V. Phone/Fax

Practice location:
  • Phone: 469-684-2351
  • Fax: 702-446-5164
Mailing address:
  • Phone: 469-684-2351
  • Fax: 702-446-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: LATOSHA RIDER
Title or Position: COORDINATOR
Credential:
Phone: 469-684-2351