Provider Demographics
NPI:1861168205
Name:GLOWING HEARTS HOME CARE SERVICES
Entity type:Organization
Organization Name:GLOWING HEARTS HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-323-3502
Mailing Address - Street 1:PO BOX 9506
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-0506
Mailing Address - Country:US
Mailing Address - Phone:862-323-3502
Mailing Address - Fax:973-318-8317
Practice Address - Street 1:561 BROAD ST FL 2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-4503
Practice Address - Country:US
Practice Address - Phone:973-318-8316
Practice Address - Fax:973-318-8317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health