Healthcare Provider Details

I. General information

NPI: 1386323699
Provider Name (Legal Business Name): AMAZING HEARTS HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 MILL POINTE CT # B
LAWRENCEVILLE GA
30043-9111
US

IV. Provider business mailing address

1418 MILL POINTE CT # B
LAWRENCEVILLE GA
30043-9111
US

V. Phone/Fax

Practice location:
  • Phone: 404-447-7927
  • Fax: 678-407-1132
Mailing address:
  • Phone: 404-447-7927
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KORPO KPISSAY ERAWOC
Title or Position: NURSE PRACTITIONER
Credential: FNP-C
Phone: 404-447-7927