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General NPI Number Information
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NPI Number | 1871113670
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Entity Type | Organization
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Legal Business Name | HEALING HEART DIRECT SERVICE CONSUMER LLC
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 52 ARBOR VILLAGE CT APT A
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City | SAINT LOUIS
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State | MO
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Zip | 63135-2975
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Country | US
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Telephone | 314-224-9426
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Fax |
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Provider Business Mailing Address
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Address Line | 52 ARBOR VILLAGE CT APT A
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City | SAINT LOUIS
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State | MO
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Zip | 63135-2975
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Country | US
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Telephone | 314-224-9426
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. LYDIA WILSON
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Credential | CMT
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Telephone | 314-224-9426
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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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