MEDICARE: PUREHEART ASSISTED LIVING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	251E00000X	Home Health Agency
3	253Z00000X	In Home Supportive Care Agency
4	3104A0625X	Assisted Living Facility (Mental Illness)
5	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1356153092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUREHEART ASSISTED LIVING

Provider Business Mailing Address
First Line	:	1911 S HEIGHTS AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44502-2947
Country	:	US
Telephone Number	:	470-435-3997
Fax Number	:

Provider Business Practice Location Address
First Line	:	189 MADISON ST
Second Line	:
City	:	CAMPBELL
State	:	OH
Zip	:	44405-1834
Country	:	US
Telephone Number	:	470-435-3997
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TYANN HODGES
Credential	:
Telephone Number	:	470-435-3997

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	01/21/2025

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Directions to “PUREHEART ASSISTED LIVING ” Practice Location

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