Healthcare Provider Details

I. General information

NPI: 1265355473
Provider Name (Legal Business Name): HEARTFELT LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 7TH AVE NW
CAIRO GA
39828-2072
US

IV. Provider business mailing address

185 7TH AVE NW
CAIRO GA
39828-2072
US

V. Phone/Fax

Practice location:
  • Phone: 229-264-7980
  • Fax: 229-264-7980
Mailing address:
  • Phone: 229-264-7980
  • Fax: 229-264-7980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: QUATERRIOUS WALDEN
Title or Position: CEO
Credential:
Phone: 229-264-7980