Provider Demographics
NPI:1366052524
Name:KREATIVE HEARTS HOMECARE LLC
Entity type:Organization
Organization Name:KREATIVE HEARTS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHENAI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS-PERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-909-5510
Mailing Address - Street 1:1621 RIDGE AVE.
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130
Mailing Address - Country:US
Mailing Address - Phone:267-909-5510
Mailing Address - Fax:267-930-7587
Practice Address - Street 1:1621 RIDGE AVE.
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130
Practice Address - Country:US
Practice Address - Phone:267-909-5510
Practice Address - Fax:267-930-7587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103624941-0001Medicaid