Provider Demographics
NPI:1104647379
Name:HEARTSWELL LIVING
Entity type:Organization
Organization Name:HEARTSWELL LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAISEGOD
Authorized Official - Middle Name:O
Authorized Official - Last Name:EKHAESOMHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-326-3646
Mailing Address - Street 1:230 NORTHLAND BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3752
Mailing Address - Country:US
Mailing Address - Phone:513-326-3646
Mailing Address - Fax:
Practice Address - Street 1:230 NORTHLAND BLVD STE 216
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3752
Practice Address - Country:US
Practice Address - Phone:513-326-3646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health