Healthcare Provider Details

I. General information

NPI: 1396468633
Provider Name (Legal Business Name): KINDRED HEARTS CARE PROVIDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 CAVE SPRINGS RD
DOUGLASVILLE GA
30134-3615
US

IV. Provider business mailing address

PO BOX 376
AUSTELL GA
30168-1017
US

V. Phone/Fax

Practice location:
  • Phone: 770-882-8585
  • Fax:
Mailing address:
  • Phone: 770-882-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIZER NJERU
Title or Position: OWNER
Credential: LPN
Phone: 770-882-8585