Healthcare Provider Details

I. General information

NPI: 1972310852
Provider Name (Legal Business Name): HEARTIFY IN HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2024
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5036 ESTONIAN DR
FAIRBURN GA
30213-2157
US

IV. Provider business mailing address

5036 ESTONIAN DR
FAIRBURN GA
30213-2157
US

V. Phone/Fax

Practice location:
  • Phone: 631-568-9144
  • Fax:
Mailing address:
  • Phone: 631-568-9144
  • Fax: 833-938-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TISHEKA LAIDLEY
Title or Position: OWNER
Credential:
Phone: 631-568-9144