=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861926552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIG HEARTS HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2017
-----------------------------------------------------
Last Update Date | 04/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 N BELVEDERE DR
-----------------------------------------------------
City | GALLATIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37066-5418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-239-4114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 BABY RUTH LN APT 103
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37013-2332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-239-4114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | SYMONE COBBS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-239-4114
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------