Provider Demographics
NPI:1417349390
Name:CARING HEARTS WELLNESS LLC
Entity Type:Organization
Organization Name:CARING HEARTS WELLNESS LLC
Other - Org Name:CARING HEARTS OF LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEEGAN
Authorized Official - Middle Name:DENZELL
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-265-4121
Mailing Address - Street 1:62250 WESTEND BLVD
Mailing Address - Street 2:120
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5622
Mailing Address - Country:US
Mailing Address - Phone:985-265-4121
Mailing Address - Fax:985-265-4161
Practice Address - Street 1:62250 WESTEND BLVD
Practice Address - Street 2:120
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5622
Practice Address - Country:US
Practice Address - Phone:985-265-4121
Practice Address - Fax:985-265-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1316337025Medicaid