Provider Demographics
NPI:1104390095
Name:SOUTHERN HEARTS HOMECARE OF GEORGIA INC
Entity Type:Organization
Organization Name:SOUTHERN HEARTS HOMECARE OF GEORGIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:
Authorized Official - First Name:NIKYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-787-2410
Mailing Address - Street 1:200 JASMINE WAY
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3512
Mailing Address - Country:US
Mailing Address - Phone:478-787-2410
Mailing Address - Fax:
Practice Address - Street 1:200 JASMINE WAY
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3512
Practice Address - Country:US
Practice Address - Phone:478-787-2410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care