MEDICARE: OUR HEALING HEART 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

General Provider Information

NPI Number	:	1588044788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR HEALING HEART HOMECARE, LLC

Provider Business Mailing Address
First Line	:	204 W SHAEFFER ST
Second Line	:
City	:	SAN DIEGO
State	:	TX
Zip	:	78384-2432
Country	:	US
Telephone Number	:	361-209-5035
Fax Number	:	361-209-5027

Provider Business Practice Location Address
First Line	:	5003 COUNTY ROAD 110
Second Line	:	UNIT C
City	:	SAN DIEGO
State	:	TX
Zip	:	78384-2432
Country	:	US
Telephone Number	:	361-209-5035
Fax Number	:	361-209-5027

Authorized Official
Title or Position	:	RN/SUPERVISING NURSE
Name	:	MRS. LIZA MARIE BARRERA
Credential	:	RN
Telephone Number	:	361-209-5035

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	11/19/2015

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