=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972172773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVING HEARTS HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2021
-----------------------------------------------------
Last Update Date | 06/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2202 BUECHEL AVE STE 103
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40218-2672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-814-4111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2202 BUECHEL AVE STE 103
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40218-2672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NURAT TEMITOPE ODENIYI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-407-4280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------