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General NPI Number Information
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NPI Number | 1003531526
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Entity Type | Organization
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Legal Business Name | HEART TO HEART PERSONAL CARE HOME
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 800 MISSISSIPPI STREET
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City | SHELBY
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State | MS
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Zip | 38774
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Country | US
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Telephone | 662-398-7133
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Fax | 662-775-5018
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Provider Business Mailing Address
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Address Line | PO BOX 1026
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City | SHELBY
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State | MS
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Zip | 38774-1026
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Country | US
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Telephone | 662-402-7133
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Fax | 662-775-5018
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Authorized Official
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Title or Position | CEO
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Name | SHARDA NICOLE JOHNSON
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Credential |
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Telephone | 662-402-6452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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