Provider Demographics
NPI:1407280811
Name:HEART TO HEART HOLISTIC HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:HEART TO HEART HOLISTIC HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-500-2542
Mailing Address - Street 1:1206 COX ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-2707
Mailing Address - Country:US
Mailing Address - Phone:601-500-2542
Mailing Address - Fax:769-208-8014
Practice Address - Street 1:1206 COX ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-2707
Practice Address - Country:US
Practice Address - Phone:601-500-2542
Practice Address - Fax:769-208-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR898458251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06779560Medicaid