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General NPI Number Information
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NPI Number | 1932709581
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Entity Type | Organization
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Legal Business Name | HEART OF MINE HOME CARE, LLC
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Dates
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Enumeration Date | 10/31/2020
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Last Update Date | 10/31/2020
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Provider Practice Location Address
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Address Line | 1521 66TH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19126-2766
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Country | US
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Telephone | 215-237-6439
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Fax |
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Provider Business Mailing Address
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Address Line | 1925 KEITH RD UNIT 9
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City | ABINGTON
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State | PA
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Zip | 19001-2628
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Country | US
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Telephone | 215-237-6439
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. TAHIRA VERNICE WILSON
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Credential | RN
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Telephone | 215-237-6439
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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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