MEDICARE: HEAVENLY HEART HOME CARE 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	:	1811460033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY HEART HOME CARE LLC

Provider Business Mailing Address
First Line	:	3236 LANDMARK DR STE 105
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-8490
Country	:	US
Telephone Number	:	843-371-4728
Fax Number	:	843-793-3621

Provider Business Practice Location Address
First Line	:	3236 LANDMARK DR STE 105
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-8490
Country	:	US
Telephone Number	:	843-371-4728
Fax Number	:	843-793-3621

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TAMMY L SMITH
Credential	:	LPN
Telephone Number	:	843-371-4728

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	01/10/2019

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