Provider Demographics
NPI:1154671626
Name:HEALING HEARTS PERSONAL CARE
Entity Type:Organization
Organization Name:HEALING HEARTS PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:OLEATHA
Authorized Official - Last Name:GOODGAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-363-5194
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-0206
Mailing Address - Country:US
Mailing Address - Phone:334-363-5194
Mailing Address - Fax:334-756-0421
Practice Address - Street 1:2011 CALGARY CRES
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-2140
Practice Address - Country:US
Practice Address - Phone:334-363-5194
Practice Address - Fax:334-756-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1258253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care