Healthcare Provider Details

I. General information

NPI: 1699698845
Provider Name (Legal Business Name): KINDRED HEARTS HOME SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 E CENTRAL PKWY
TRACY CA
95391-8288
US

IV. Provider business mailing address

263 E CENTRAL PKWY
TRACY CA
95391-8288
US

V. Phone/Fax

Practice location:
  • Phone: 209-445-8858
  • Fax:
Mailing address:
  • Phone: 209-445-8858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY GRANT
Title or Position: FOUNDER
Credential:
Phone: 209-445-8858