MEDICARE: KREATIVE HEARTS HOMECARE 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	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

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	:	1366052524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KREATIVE HEARTS HOMECARE LLC

Provider Business Mailing Address
First Line	:	1621 RIDGE AVE.
Second Line	:	1ST FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130
Country	:	US
Telephone Number	:	267-909-5510
Fax Number	:	267-930-7587

Provider Business Practice Location Address
First Line	:	1621 RIDGE AVE.
Second Line	:	1ST FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130
Country	:	US
Telephone Number	:	267-909-5510
Fax Number	:	267-930-7587

Authorized Official
Title or Position	:	CEO
Name	:	CHENAI WOODS-PERSON
Credential	:
Telephone Number	:	267-909-5510

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	02/14/2024

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