MEDICARE: HEART 2 HOME SENIOR SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1194595330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART 2 HOME SENIOR SERVICES, LLC

Provider Business Mailing Address
First Line	:	102 VILLAGE DR APT 236
Second Line	:
City	:	MEBANE
State	:	NC
Zip	:	27302-9867
Country	:	US
Telephone Number	:	336-264-5767
Fax Number	:

Provider Business Practice Location Address
First Line	:	3511 SHANNON RD STE 300
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-6330
Country	:	US
Telephone Number	:	336-264-5767
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	STACIE LORITA JOHNSON
Credential	:
Telephone Number	:	336-264-5767

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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