Provider Demographics
NPI:1093995730
Name:CONNECTING HEARTS RESIDENTIAL SERVICES INC
Entity Type:Organization
Organization Name:CONNECTING HEARTS RESIDENTIAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHITOKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-474-1130
Mailing Address - Street 1:103 GASTON ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-7138
Mailing Address - Country:US
Mailing Address - Phone:205-345-0529
Mailing Address - Fax:
Practice Address - Street 1:2216B 15TH ST
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-4611
Practice Address - Country:US
Practice Address - Phone:205-345-0529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========00Medicaid