MEDICARE: CAPTURING HEARTS 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	:	1700416161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPTURING HEARTS LLC

Provider Business Mailing Address
First Line	:	1304 BERTRAND DR STE D5
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-9104
Country	:	US
Telephone Number	:	337-446-1223
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 BERTRAND DR STE D5
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-9104
Country	:	US
Telephone Number	:	337-446-1223
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRYSTAL YOUNG
Credential	:	LPN
Telephone Number	:	337-446-1223

Provider Enumeration Date	:	01/24/2020
Last Update Date	:	02/05/2020

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Directions to “CAPTURING HEARTS LLC ” Practice Location

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