=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285221820
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURE HEARTS HOMECARE SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2020
-----------------------------------------------------
Last Update Date | 12/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3015 INVERGARRY RD
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38128-5183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-413-4774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1779 KIRBY PKWY # 1-365
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38138-3666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-413-4774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. TATYANA RENEE BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-413-4774
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------