Healthcare Provider Details

I. General information

NPI: 1689210064
Provider Name (Legal Business Name): CHANGING HEARTS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 COOPER WOODS LN
LOGANVILLE GA
30052-8215
US

IV. Provider business mailing address

3024 COOPER WOODS LN
LOGANVILLE GA
30052-8215
US

V. Phone/Fax

Practice location:
  • Phone: 216-338-8233
  • Fax:
Mailing address:
  • Phone:
  • 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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KENYA D SMITH
Title or Position: OWNER
Credential:
Phone: 216-338-8233