Healthcare Provider Details

I. General information

NPI: 1003416496
Provider Name (Legal Business Name): HEALING HEARTSNC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 HWY 211 WEST
CLARKTON NC
28433
US

IV. Provider business mailing address

PO BOX 264
CLARKTON NC
28433-0264
US

V. Phone/Fax

Practice location:
  • Phone: 336-213-4319
  • Fax:
Mailing address:
  • Phone: 336-213-4319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS LASHAI R AUSTIN
Title or Position: OWNER
Credential:
Phone: 336-213-4319