Provider Demographics
NPI:1427644228
Name:LOYAL HEARTS STNA SERVICE
Entity type:Organization
Organization Name:LOYAL HEARTS STNA SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-884-1356
Mailing Address - Street 1:5530 HAMILTON AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-3141
Mailing Address - Country:US
Mailing Address - Phone:513-884-1356
Mailing Address - Fax:513-873-7792
Practice Address - Street 1:5530 HAMILTON AVE APT 12
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-3141
Practice Address - Country:US
Practice Address - Phone:513-884-1356
Practice Address - Fax:513-873-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health