MEDICARE: H.E.A.R.T. HOME CARE OF GA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1699486027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H.E.A.R.T. HOME CARE OF GA LLC

Provider Business Mailing Address
First Line	:	1000 EDGEWATER DR
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-3749
Country	:	US
Telephone Number	:	229-869-5945
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 N WESTOVER BLVD STE D4
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-2102
Country	:	US
Telephone Number	:	229-869-5945
Fax Number	:

Authorized Official
Title or Position	:	CNA/CO-OWNER
Name	:	MRS. COURTNEY S HALL
Credential	:
Telephone Number	:	229-869-5945

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	12/13/2022

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