MEDICARE: SHARED HEARTS 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1306511480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARED HEARTS LLC

Provider Business Mailing Address
First Line	:	19200 SPACE CENTER BLVD APT 1821
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3853
Country	:	US
Telephone Number	:	832-978-8810
Fax Number	:

Provider Business Practice Location Address
First Line	:	19200 SPACE CENTER BLVD APT 1821
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3853
Country	:	US
Telephone Number	:	832-978-8810
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JULIE MATHEWS
Credential	:
Telephone Number	:	832-978-8810

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	08/11/2021

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Directions to “SHARED HEARTS LLC ” Practice Location

Language	Start Address	Practice Location

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