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General NPI Number Information
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NPI Number | 1083356638
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Entity Type | Organization
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Legal Business Name | A HEART FULL OF LOVE HOME HEALTH LLC
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 10000 N 31ST AVE STE D304B
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City | PHOENIX
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State | AZ
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Zip | 85051-9582
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Country | US
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Telephone | 314-269-6907
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Fax |
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Provider Business Mailing Address
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Address Line | 10000 N 31ST AVE STE D304B
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City | PHOENIX
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State | AZ
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Zip | 85051-9582
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Country | US
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Telephone | 314-269-6907
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA L GREGORY
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Credential | OWNER
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Telephone | 314-269-6907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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