Provider Demographics
| NPI: | 1871163154 |
|---|---|
| Name: | HALO HEART CARE LLC |
| Entity type: | Organization |
| Organization Name: | HALO HEART CARE LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CO-OWNER |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | QUEENELLA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | WISNER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 267-401-7675 |
| Mailing Address - Street 1: | 71 RANDALL AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | TRENTON |
| Mailing Address - State: | NJ |
| Mailing Address - Zip Code: | 08611-2509 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 267-401-7675 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 71 RANDALL AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | TRENTON |
| Practice Address - State: | NJ |
| Practice Address - Zip Code: | 08611-2509 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 267-401-7675 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2021-06-29 |
| Last Update Date: | 2023-01-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 251E00000X | Agencies | Home Health | |
| No | 251B00000X | Agencies | Case Management | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
| No | 251G00000X | Agencies | Hospice Care, Community Based | |
| No | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 253Z00000X | Agencies | In Home Supportive Care | |
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 347E00000X | Transportation Services | Transportation Broker |
