Organization
ILLUMINATED HEARTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIONNA PERRY (CO FOUNDER)
(610) 324-7807
Entity
Organization
Contact information
Practice address
3900 FORD RD, STE 104E, PHILADELPHIA, PA 19131-2039
(215) 921-6624
(215) 921-6715
Mailing address
3900 FORD RD, STE 104E, PHILADELPHIA, PA 19131-2039
(215) 921-6624
(215) 921-6715
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
28383601
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103052059
MPI NUMBER
PA
Enumeration date
04/11/2016
Last updated
04/11/2016
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