=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073476297
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEEANNS CARING HEART HOMECARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4320 ENDANGERED CT
-----------------------------------------------------
City | DOUGLASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30135-8236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-979-1603
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 NORTHSIDE DR NW STE A7
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30318-2695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-979-1603
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO /OWNER
-----------------------------------------------------
Name | IESHA LATAY POTTS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 470-979-1603
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------