Healthcare Provider Details

I. General information

NPI: 1841860590
Provider Name (Legal Business Name): CARING HEARTS RESPITE AND SITTER SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 YORK DR
DESOTO TX
75115-2043
US

IV. Provider business mailing address

923 YORK DR
DESOTO TX
75115-2043
US

V. Phone/Fax

Practice location:
  • Phone: 501-416-8045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JACQUELINE JOHNSON
Title or Position: APRN
Credential:
Phone: 501-416-8045