Healthcare Provider Details

I. General information

NPI: 1851048003
Provider Name (Legal Business Name): HEART TO HEART PROVISION HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 E BROAD ST
MONTICELLO MS
39654-7681
US

IV. Provider business mailing address

1132 E BROAD ST
MONTICELLO MS
39654-7681
US

V. Phone/Fax

Practice location:
  • Phone: 601-695-2452
  • Fax:
Mailing address:
  • Phone: 601-695-2452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: TRINITY C BROWN
Title or Position: CLINICAL DIRECTOR
Credential: RN
Phone: 601-695-2452