Provider Demographics
NPI:1144404765
Name:HEART 2 HEART HOSPICE
Entity Type:Organization
Organization Name:HEART 2 HEART HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-763-1456
Mailing Address - Street 1:2981 CHURCH ST
Mailing Address - Street 2:STE 214
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-4156
Mailing Address - Country:US
Mailing Address - Phone:404-763-1456
Mailing Address - Fax:404-763-4115
Practice Address - Street 1:2981 CHURCH ST
Practice Address - Street 2:STE 214
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-4156
Practice Address - Country:US
Practice Address - Phone:404-763-1456
Practice Address - Fax:404-763-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-0250-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111662Medicare Oscar/Certification