Provider Demographics
NPI:1043557663
Name:KIND HEARTS SENIOR CARE, LLC
Entity Type:Organization
Organization Name:KIND HEARTS SENIOR CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WHATCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-619-6631
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84771-2168
Mailing Address - Country:US
Mailing Address - Phone:435-275-1656
Mailing Address - Fax:435-275-1656
Practice Address - Street 1:168 NORTH 100 EAST
Practice Address - Street 2:SUITE #207
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-275-1656
Practice Address - Fax:435-275-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2012-PCA-UT000542253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care