MEDICARE: CARING HEARTS AND MINDS 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1770187411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARING HEARTS AND MINDS LLC

Provider Business Mailing Address
First Line	:	2609 PINEY RIDGE DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-2156
Country	:	US
Telephone Number	:	804-972-9903
Fax Number	:	804-447-8059

Provider Business Practice Location Address
First Line	:	2609 PINEY RIDGE DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-2156
Country	:	US
Telephone Number	:	804-972-9903
Fax Number	:	804-447-8059

Authorized Official
Title or Position	:	OWNER
Name	:	ERICA TYNEK BALLOU
Credential	:
Telephone Number	:	804-972-9903

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	11/23/2020

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