Provider Demographics
NPI:1649644659
Name:FIVE HEARTS HEALTHCARE LLC
Entity type:Organization
Organization Name:FIVE HEARTS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-445-1800
Mailing Address - Street 1:132 W HOWZE BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8501
Mailing Address - Country:US
Mailing Address - Phone:985-445-1800
Mailing Address - Fax:985-445-1802
Practice Address - Street 1:132 W HOWZE BEACH RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8501
Practice Address - Country:US
Practice Address - Phone:985-445-1800
Practice Address - Fax:985-445-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-15
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1737712Medicaid