Provider Demographics
NPI:1396585105
Name:PRACTITIONER'S HEART HOMEBASED HEALTHCARE LLC
Entity type:Organization
Organization Name:PRACTITIONER'S HEART HOMEBASED HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:804-439-2120
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-0254
Mailing Address - Country:US
Mailing Address - Phone:804-439-2120
Mailing Address - Fax:276-325-5604
Practice Address - Street 1:1103 W ROSLYN RD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3909
Practice Address - Country:US
Practice Address - Phone:804-439-2120
Practice Address - Fax:276-325-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty