Healthcare Provider Details

I. General information

NPI: 1558014134
Provider Name (Legal Business Name): OPEN HEARTS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 N PINE ST
LUMBERTON NC
28358-3936
US

IV. Provider business mailing address

121 S ACLINE ST
LAKE CITY SC
29560-2632
US

V. Phone/Fax

Practice location:
  • Phone: 910-370-0274
  • Fax:
Mailing address:
  • Phone: 843-939-0810
  • Fax: 843-699-9327

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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ANDRE GRAHA
Title or Position: DIRECTOR
Credential:
Phone: 843-939-0810