Healthcare Provider Details

I. General information

NPI: 1366297194
Provider Name (Legal Business Name): HEARTFELT CONNECTIONS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 TEXAS BLACK WAY
ELGIN SC
29045-9813
US

IV. Provider business mailing address

6729 TWO NOTCH RD STE. M #1013
COLUMBIA SC
29223
US

V. Phone/Fax

Practice location:
  • Phone: 803-563-7789
  • Fax:
Mailing address:
  • Phone: 803-563-7789
  • Fax:

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: RONNISHA SIMON
Title or Position: CEO
Credential:
Phone: 803-563-7789