Provider Demographics
NPI:1316575996
Name:AFFILIATED HEART2HEART HOMECARE SERVICES, INC.
Entity Type:Organization
Organization Name:AFFILIATED HEART2HEART HOMECARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAWANNA
Authorized Official - Middle Name:TYRELLE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-752-6262
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-0854
Mailing Address - Country:US
Mailing Address - Phone:985-795-1704
Mailing Address - Fax:985-795-1706
Practice Address - Street 1:1001 15TH AVE
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-2101
Practice Address - Country:US
Practice Address - Phone:985-795-1704
Practice Address - Fax:985-795-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1463043Medicaid