Healthcare Provider Details

I. General information

NPI: 1619807542
Provider Name (Legal Business Name): HEARTIFY IN HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/18/2026
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: 833-938-3977
Mailing address:
  • Phone: 631-568-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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