Enchanted Hearts Provider Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

ENCHANTED HEARTS PROVIDER SERVICES LLC

Doing business as

Enchanted Hearts Provider Services LLC

Practice address

825 Boyd St
Beaumont, TX 77705-5007

Phone

(409) 527-1121

NPI assigned

Apr 21, 2023

Organization subpart

No

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

Authorized official

Name

Miss Dorian Olevia Martin, RN

Title

Ceo

Phone

(409) 527-1121

Specialties & licenses 3

Addresses

Other names 1

• Enchanted Hearts Provider Services LLC Doing business as

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

{
    "created_epoch": "1682035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682035200000",
    "number": "1760179584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 BOYD ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777055007",
            "telephone_number": "409-527-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 BOYD ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777055007",
            "telephone_number": "409-527-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENCHANTED HEARTS PROVIDER SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-21",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "DORIAN",
        "authorized_official_middle_name": "OLEVIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "409-527-1121",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Enchanted Hearts Provider Services LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.