Healthcare Provider Details

I. General information

NPI: 1730806902
Provider Name (Legal Business Name): KAYS HEART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 03/25/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WINDSOR ROAD
SAVANNAH GA
31419-2647
US

IV. Provider business mailing address

18720 KENOSHA ST
DETROIT MI
48225-2128
US

V. Phone/Fax

Practice location:
  • Phone: 248-525-3424
  • Fax:
Mailing address:
  • Phone: 248-525-3424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: EMELIN T COOK
Title or Position: CEO
Credential: REGISTERED NURSE
Phone: 248-525-3424