Healthcare Provider Details

I. General information

NPI: 1487264909
Provider Name (Legal Business Name): VS SERVANT HEARTS HOME CARE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S MAGNOLIA ST
HEARNE TX
77859
US

IV. Provider business mailing address

404 E BROWN ST
HEARNE TX
77859-3155
US

V. Phone/Fax

Practice location:
  • Phone: 979-393-0254
  • Fax:
Mailing address:
  • Phone: 979-393-0254
  • Fax:

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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: LAVOSHA BENFORD
Title or Position: ADMINISTRATOR
Credential:
Phone: 979-446-9594