Healthcare Provider Details

I. General information

NPI: 1891398715
Provider Name (Legal Business Name): LOVING HEARTS HOMECARE AND NURSE ADVOCATE SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3581 MAIN ST STE 105
COLLEGE PARK GA
30337-2623
US

IV. Provider business mailing address

1224 ITHACA DR
MCDONOUGH GA
30253-6885
US

V. Phone/Fax

Practice location:
  • Phone: 678-937-6659
  • Fax:
Mailing address:
  • Phone: 678-937-6659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TOMEKA KHAALIQ
Title or Position: CEO/ADMINISTRATOR
Credential: LPN
Phone: 678-937-6659