Healthcare Provider Details

I. General information

NPI: 1063397545
Provider Name (Legal Business Name): KINDRED HEART FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 HOUSTON LAKE RD APT 813
KATHLEEN GA
31047-5413
US

IV. Provider business mailing address

2350 HOUSTON LAKE RD APT 813
KATHLEEN GA
31047-5413
US

V. Phone/Fax

Practice location:
  • Phone: 678-939-5697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: SABRINA DELGADO
Title or Position: CLINICAL DIRECTOR
Credential: BCBA
Phone: 678-939-5697