MEDICARE: HELPING HANDS HEALING HEARTS

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	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1285822486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HELPING HANDS HEALING HEARTS

Provider Business Mailing Address
First Line	:	6400 W MAIN ST
Second Line	:	STE. 1Q
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-3806
Country	:	US
Telephone Number	:	618-791-1997
Fax Number	:	618-222-7949

Provider Business Practice Location Address
First Line	:	6400 W MAIN ST
Second Line	:	STE. 1Q
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-3806
Country	:	US
Telephone Number	:	618-791-1997
Fax Number	:	618-222-7949

Authorized Official
Title or Position	:	CEO
Name	:	MRS. KARI B HARRIS
Credential	:	MSW, LCSW
Telephone Number	:	618-791-1997

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	10/12/2007

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