MEDICARE: HEAVENLY HEARTS ADULT DAYCARE LLC

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	261QA0600X	Adult Day Care Clinic/Center	143231	TX

General Provider Information

NPI Number	:	1144699901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY HEARTS ADULT DAYCARE LLC

Provider Business Mailing Address
First Line	:	2034 AUSTIN HWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-2503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2034 AUSTIN HWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-2503
Country	:	US
Telephone Number	:	210-777-1039
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOYCE KYLE
Credential	:
Telephone Number	:	210-777-1039

Provider Enumeration Date	:	09/22/2015
Last Update Date	:	09/22/2015

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