MEDICARE: OPEN YOUR HEART

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	332U00000X	Home Delivered Meals
2	251B00000X	Case Management Agency		NC

General Provider Information

NPI Number	:	1730339094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN YOUR HEART

Provider Business Mailing Address
First Line	:	401 HAWTHORNE LN # 110-273
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2484
Country	:	US
Telephone Number	:	704-372-7239
Fax Number	:

Provider Business Practice Location Address
First Line	:	3722 MONROE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7736
Country	:	US
Telephone Number	:	704-372-7239
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MRS. CRYSTAL B WALKER
Credential	:
Telephone Number	:	704-372-7239

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	09/23/2008

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Directions to “OPEN YOUR HEART ” Practice Location

Language	Start Address	Practice Location

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