MEDICARE: HEART TO HOME INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311500000X	Alzheimer Center (Dementia Center)	25755	MN
2	310400000X	Assisted Living Facility	25755	MN

General Provider Information

NPI Number	:	1013373117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART TO HOME INCORPORATED

Provider Business Mailing Address
First Line	:	659 FREEWAY RD S
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55118-4314
Country	:	US
Telephone Number	:	651-485-8738
Fax Number	:	651-686-5295

Provider Business Practice Location Address
First Line	:	2351 PAGEL RD
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-1638
Country	:	US
Telephone Number	:	651-994-2020
Fax Number	:	651-686-5295

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JOSHUA WILLIAM CESARO-MOXLEY
Credential	:
Telephone Number	:	651-485-8738

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	01/06/2016

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Directions to “HEART TO HOME INCORPORATED ” Practice Location

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