Healthcare Provider Details

I. General information

NPI: 1881557759
Provider Name (Legal Business Name): KINDHEARTED HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 CRESTWOOD DR
DALLAS GA
30157-2583
US

IV. Provider business mailing address

208 CRESTWOOD DR
DALLAS GA
30157-2583
US

V. Phone/Fax

Practice location:
  • Phone: 708-257-8504
  • Fax:
Mailing address:
  • Phone: 708-257-8504
  • 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: MRS. TEASA EZEH
Title or Position: OWNER
Credential:
Phone: 708-257-8504