=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437956976
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAITHFUL HEARTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2025
-----------------------------------------------------
Last Update Date | 04/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4780 I 55 N STE 100
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39211-5583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-417-2928
-----------------------------------------------------
Fax | 601-996-4087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4780 I 55 N STE 100
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39211-5583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-996-4096
-----------------------------------------------------
Fax | 601-996-4087
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | TIFFANY HEARD
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 901-417-2928
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------