Provider Demographics
NPI:1407251879
Name:CARING HEARTS SUPPORTIVE SERVICES, LLC
Entity Type:Organization
Organization Name:CARING HEARTS SUPPORTIVE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-552-2769
Mailing Address - Street 1:808 KRAFT ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-4935
Mailing Address - Country:US
Mailing Address - Phone:931-552-2769
Mailing Address - Fax:931-553-8003
Practice Address - Street 1:808 KRAFT ST
Practice Address - Street 2:SUITE D
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-4935
Practice Address - Country:US
Practice Address - Phone:931-552-2769
Practice Address - Fax:931-553-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251B00000X
TNL000000013100251C00000X, 251T00000X, 253Z00000X, 320600000X, 320900000X
253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========Medicaid