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General NPI Number Information
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NPI Number | 1942572888
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Entity Type | Organization
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Legal Business Name | MARTIN'S HEART;S 2 HEARTS INDEPENDENT CARE AGENCY
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 5366 STEEPLE CHASE
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1247
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Country | US
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Telephone | 678-913-5216
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Fax |
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Provider Business Mailing Address
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Address Line | 6140 COOPER ST
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6925
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS RESHANDA MARTIN
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Credential | PCT
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Telephone | 678-913-5216
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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 | CN0028902990
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License Number State | GA
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