MEDICARE: GIFTED HEART HOME HEALTH CARE 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

General Provider Information

NPI Number	:	1407516875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFTED HEART HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	5810 SOUTHWYCK BLVD # 203
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1518
Country	:	US
Telephone Number	:	419-214-4761
Fax Number	:	419-385-7162

Provider Business Practice Location Address
First Line	:	5810 SOUTHWYCK BLVD # 203
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1518
Country	:	US
Telephone Number	:	419-214-4761
Fax Number	:	419-385-7162

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	JOSEPH C DENNIS
Credential	:
Telephone Number	:	419-214-4761

Provider Enumeration Date	:	12/27/2021
Last Update Date	:	12/27/2021

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