Organization Active NPI

Heart to Heart Hospice of Northwest Indiana LLC

  • Community Based Hospice Care Agency
  • Valparaiso, IN
National Provider Identifier
1023667755
Registry record updated May 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
HEART TO HEART HOSPICE OF NORTHWEST INDIANA LLC
Practice address
402 Wall St Ste 51
Valparaiso, IN 46383-2567
Phone
(219) 252-4860
Fax
(219) 895-2301
NPI assigned
Sep 5, 2019
Last updated
May 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kelly O Mitchell
Title
Manager
Phone
(972) 517-6300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

402 Wall St Ste 51
Valparaiso, IN 46383-2567

Mailing address

7240 Chase Oaks Blvd
Plano, TX 75025-5901
Phone (972) 517-6300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191203002478 IN Part A Provider - Hospice 2365875457 Practice locations: Merrillville, IN; Valparaiso, IN
O20240826000093 IN Part B Supplier - Clinic/Group Practice 2365875457 Receives reassigned benefits from 1 practitioner
Practice locations: Valparaiso, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023667755. Details of each certification follow.

Hospice certification: CCN 151632

Legal name
HEART TO HEART HOSPICE OF NORTHWEST INDIANA, LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 25, 2020
Last certification
Jun 25, 2020
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
Sep 3, 2019 in IN
Enrollment address
402 Wall St
Ste 12
Valparaiso, IN 46383-2567

Care Compare: Hospice

Medicare Care Compare
Listed as
Heart to Heart Hospice of Northwest Indiana, LLCCCN 151632 · All quality measures
Ownership
For-Profit
Certified
Jun 25, 2020
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2173837Heart to Heart Hospice of Northwest Indiana, LLC402 Wall Street, Suite 12, Valparaiso, IN 46383Certificate of waiverOct 20, 2027

National Provider Directory

National Provider Directory

Locations

9111 Broadway
Ste Cc
Merrillville, IN 46410
Phone (219) 713-0653

402 Wall St
Ste 12
Valparaiso, IN 46383
Phone (219) 252-4860

402 Wall St
Ste 51
Valparaiso, IN 46383
Phone (219) 252-4860

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Indiana Hospice DFW, LLC Organization, Dallas, TX LLC 5% Or Greater Indirect Ownership Interest Sep 3, 2019 6.25%
Heart to Heart Indiana Holdco, LLC Organization, Plano, TX LLC 5% Or Greater Direct Ownership Interest Sep 3, 2019 100%
Courtney Fokianos Individual W-2 Managing EmployeeAd; Aug 10, 2022
Heart to Heart Hospice Holdings LLC Organization, Plano, TX LLC 5% Or Greater Indirect Ownership Interest Sep 3, 2019 100%
Indiana Hospice DFW Two, LLC Organization, Plano, TX LLC 5% Or Greater Indirect Ownership Interest Sep 3, 2019 6.25%
H to H Founders, LLC Organization, Plano, TX LLC 5% Or Greater Indirect Ownership Interest Sep 3, 2019 59.83%
Htohh Preferred LLC Organization, Plano, TX LLC 5% Or Greater Indirect Ownership Interest Sep 3, 2019 39.92%
Nadeem Kamran Individual Contracted Managing EmployeeMD; May 5, 2022
Indiana Medical Couriers and Express Delivery Services, LLC Organization, Plano, TX LLC 5% Or Greater Indirect Ownership Interest Sep 3, 2019 87.5%
Kelly Mitchell Individual Corporate OfficerManager Sep 3, 2019
W-2 Managing EmployeeManager Sep 3, 2019

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 40

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 40

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588636800000",
    "number": "1023667755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7240 CHASE OAKS BLVD",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750255901",
            "telephone_number": "972-517-6300",
            "fax_number": "972-517-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 WALL ST STE 51",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832567",
            "telephone_number": "219-252-4860",
            "fax_number": "219-895-2301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART TO HEART HOSPICE OF NORTHWEST INDIANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-05",
        "last_updated": "2020-05-05",
        "certification_date": "2020-05-05",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "972-517-6300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valparaiso, IN

Sources for this page

Verify at the official NPI Registry.