Healthcare Provider Details

I. General information

NPI: 1962385278
Provider Name (Legal Business Name): LOYAL HEARTS OF SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HABERSHAM DR STE 149&151
FAYETTEVILLE GA
30214-1381
US

IV. Provider business mailing address

75 WASHINGTON ST UNIT 1717
FAIRBURN GA
30213-3617
US

V. Phone/Fax

Practice location:
  • Phone: 678-374-1180
  • Fax:
Mailing address:
  • Phone: 678-374-1180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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
# 3
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OLUWAFUNMILOLA SULAIMON
Title or Position: DNP,MSN,PMHNP-BC
Credential: DNP
Phone: 678-374-1180