Healthcare Provider Details

I. General information

NPI: 1043121965
Provider Name (Legal Business Name): KATHY & IRVIN'S HEART OF CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N AVONDALE RD STE 245
AVONDALE ESTATES GA
30002-1380
US

IV. Provider business mailing address

122 N AVONDALE RD STE 245
AVONDALE ESTATES GA
30002-1380
US

V. Phone/Fax

Practice location:
  • Phone: 678-824-6831
  • Fax: 678-824-6833
Mailing address:
  • Phone: 678-824-6831
  • Fax: 678-824-6833

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: GRAVEZANDRA MATHURIN
Title or Position: OWNER
Credential:
Phone: 678-824-6831