Healthcare Provider Details

I. General information

NPI: 1679485445
Provider Name (Legal Business Name): LOYAL HEARTS OF SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6274 BALTUSROL TRCE
FAIRBURN GA
30213-5122
US

IV. Provider business mailing address

75 WASHINGTON ST
FAIRBURN GA
30213-3626
US

V. Phone/Fax

Practice location:
  • Phone: 470-800-3396
  • Fax:
Mailing address:
  • Phone: 470-800-3396
  • 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: OLUWAFUNMILOLA O SULAIMON
Title or Position: DNP,PMHNP-BC
Credential:
Phone: 888-976-5822