Provider Demographics
NPI:1053854620
Name:CLARA HEARTS
Entity Type:Organization
Organization Name:CLARA HEARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT SUPPORT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-289-7082
Mailing Address - Street 1:3327 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4131
Mailing Address - Country:US
Mailing Address - Phone:901-289-7082
Mailing Address - Fax:
Practice Address - Street 1:3327 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4131
Practice Address - Country:US
Practice Address - Phone:901-289-7082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care