Provider Demographics
NPI:1942017850
Name:WOUNDED HEARTS LLC,
Entity type:Organization
Organization Name:WOUNDED HEARTS LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTIONIO
Authorized Official - Middle Name:LARNELL
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:708-897-1155
Mailing Address - Street 1:628 E 89TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6834
Mailing Address - Country:US
Mailing Address - Phone:708-897-1155
Mailing Address - Fax:
Practice Address - Street 1:628 E 89TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6834
Practice Address - Country:US
Practice Address - Phone:708-897-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty