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General NPI Number Information
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NPI Number | 1851609077
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Entity Type | Organization
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Legal Business Name | CHERISHED HEARTS PRIVATE HOME CARE, LLC
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 115 COMMERCE DR STE H
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7335
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Country | US
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Telephone | 770-719-9333
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Fax | 770-719-9334
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Provider Business Mailing Address
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Address Line | 115 COMMERCE DR STE H
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7335
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Country | US
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Telephone | 770-719-9333
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Fax | 770-719-9334
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | MS. TUVACHE D MOODY
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Credential |
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Telephone | 770-719-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 060R0387
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License Number State | GA
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