Provider Demographics
NPI:1235968918
Name:PERIDOT HEARTS HOME HEALTH LLC
Entity type:Organization
Organization Name:PERIDOT HEARTS HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLATUNBOSUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-685-2529
Mailing Address - Street 1:11227 BALMULLO CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1882
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11227 BALMULLO CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1882
Practice Address - Country:US
Practice Address - Phone:469-685-2529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health