Provider Demographics
NPI:1003531526
Name:HEART TO HEART PERSONAL CARE HOME
Entity Type:Organization
Organization Name:HEART TO HEART PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARDA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-402-6452
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MS
Mailing Address - Zip Code:38774-1026
Mailing Address - Country:US
Mailing Address - Phone:662-402-7133
Mailing Address - Fax:662-775-5018
Practice Address - Street 1:800 MISSISSIPPI STREET
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MS
Practice Address - Zip Code:38774
Practice Address - Country:US
Practice Address - Phone:662-398-7133
Practice Address - Fax:662-775-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS007821551Medicaid
MS000254505Medicaid