=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770034555
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEDICATED HEARTS CAREGIVERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2016
-----------------------------------------------------
Last Update Date | 03/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 N LOOP 336 W STE 5B
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77301-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-442-8223
-----------------------------------------------------
Fax | 936-494-2496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 N LOOP 336 W STE 5B
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77301-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-442-8223
-----------------------------------------------------
Fax | 936-494-2496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | WAMESHIA HATCHETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 936-442-8223
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------