MEDICARE: HEART TO HEART PROVIDER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	343900000X	Non-emergency Medical Transport (VAN)
2	172A00000X	Driver
3	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1780846568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART TO HEART PROVIDER LLC

Provider Business Mailing Address
First Line	:	3836 MORNING SPRINGS TRL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-5014
Country	:	US
Telephone Number	:	469-684-2351
Fax Number	:	702-446-5164

Provider Business Practice Location Address
First Line	:	3836 MORNING SPRINGS TRL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-5014
Country	:	US
Telephone Number	:	469-684-2351
Fax Number	:	702-446-5164

Authorized Official
Title or Position	:	COORDINATOR
Name	:	LATOSHA RIDER
Credential	:
Telephone Number	:	469-684-2351

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	05/15/2015

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Directions to “HEART TO HEART PROVIDER LLC ” Practice Location

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