Provider Demographics
NPI:1083093694
Name:HEART TO HEART PROVIDER LLC
Entity type:Organization
Organization Name:HEART TO HEART PROVIDER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LATOSHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-714-1386
Mailing Address - Street 1:PO BOX 382781
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75138-2781
Mailing Address - Country:US
Mailing Address - Phone:800-520-9072
Mailing Address - Fax:702-446-5164
Practice Address - Street 1:3836 MORNING SPRINGS TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-5014
Practice Address - Country:US
Practice Address - Phone:214-714-1386
Practice Address - Fax:702-446-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343800000X, 385H00000X, 311Z00000X, 320700000X, 324500000X, 343800000X, 385H00000X, 310400000X
347E00000X, 172A00000X, 343900000X, 302F00000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker
No172A00000XOther Service ProvidersDriver
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041687066Medicaid