MEDICARE: @ HEART HOME CARE

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	302R00000X	Health Maintenance Organization

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306076914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	@ HEART HOME CARE

Provider Business Mailing Address
First Line	:	PO BOX 4613
Second Line	:
City	:	WINDOW ROCK
State	:	AZ
Zip	:	86515-4613
Country	:	US
Telephone Number	:	505-406-4269
Fax Number	:

Provider Business Practice Location Address
First Line	:	HIGHWAY 264 LOS VERDES TRAILER COURTS
Second Line	:
City	:	SAINT MICHAELS
State	:	AZ
Zip	:	86511
Country	:	US
Telephone Number	:	505-406-4269
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. PEARLINE CHIA
Credential	:
Telephone Number	:	505-406-4269

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	07/16/2009

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Directions to “@ HEART HOME CARE ” Practice Location

Language	Start Address	Practice Location

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