Healthcare Provider Details

I. General information

NPI: 1659792422
Provider Name (Legal Business Name): SACRED HEART HOME LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2013
Last Update Date: 12/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 RUGBY CT
PALMETTO GA
30268-8645
US

IV. Provider business mailing address

501 RUGBY CT
PALMETTO GA
30268-8645
US

V. Phone/Fax

Practice location:
  • Phone: 678-561-0379
  • Fax:
Mailing address:
  • Phone: 678-561-0379
  • Fax: 877-230-4123

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIE DACHA PROSPER
Title or Position: DIRECTOR
Credential:
Phone: 678-561-0379