Healthcare Provider Details

I. General information

NPI: 1003720186
Provider Name (Legal Business Name): MIRRORS OF THE HEART INDEPENDENT LIVING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 RIVERWOOD CIR
DECATUR GA
30035-2929
US

IV. Provider business mailing address

4316 RIVERWOOD CIR
DECATUR GA
30035-2929
US

V. Phone/Fax

Practice location:
  • Phone: 669-226-0381
  • Fax: 559-408-5589
Mailing address:
  • Phone: 669-226-0381
  • Fax: 559-408-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LIVIA BROWN
Title or Position: CASE MANAGER/CASE MANAGEMENT AGENCY
Credential: MS
Phone: 669-226-0381