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General NPI Number Information
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NPI Number | 1104676923
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Entity Type | Organization
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Legal Business Name | HEART FILLED CAREGIVER SERVICES, LLC.
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 2424 N HOLLYWOOD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19132-3012
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Country | US
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Telephone | 267-904-1958
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Fax |
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Provider Business Mailing Address
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Address Line | 2424 N HOLLYWOOD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19132-3012
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Country | US
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Telephone | 267-904-1958
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DONCHELLE JACKSON
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Credential |
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Telephone | 267-904-1958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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