Healthcare Provider Details

I. General information

NPI: 1972342087
Provider Name (Legal Business Name): HEART'S HAVEN HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 GORDON HWY STE D
AUGUSTA GA
30909-4406
US

IV. Provider business mailing address

1905 GORDON HWY STE D
AUGUSTA GA
30909-4406
US

V. Phone/Fax

Practice location:
  • Phone: 706-664-4608
  • Fax: 706-786-0771
Mailing address:
  • Phone: 706-664-4608
  • Fax: 706-786-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS ALEXIS WILLIAMS
Title or Position: CEO
Credential:
Phone: 706-664-4608