Provider Demographics
NPI:1104676923
Name:HEART FILLED CAREGIVER SERVICES, LLC.
Entity type:Organization
Organization Name:HEART FILLED CAREGIVER SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-904-1958
Mailing Address - Street 1:2424 N HOLLYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-3012
Mailing Address - Country:US
Mailing Address - Phone:267-904-1958
Mailing Address - Fax:
Practice Address - Street 1:2424 N HOLLYWOOD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-3012
Practice Address - Country:US
Practice Address - Phone:267-904-1958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care