Provider Demographics
NPI:1518572973
Name:ENCHANTED HEARTS HOME CARE SERVICES LLC.
Entity Type:Organization
Organization Name:ENCHANTED HEARTS HOME CARE SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUANISHA
Authorized Official - Middle Name:ALIYAH
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-910-3580
Mailing Address - Street 1:PO BOX 9373
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-9373
Mailing Address - Country:US
Mailing Address - Phone:706-799-3017
Mailing Address - Fax:
Practice Address - Street 1:119 DAVIS RD STE 5C
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0217
Practice Address - Country:US
Practice Address - Phone:706-799-3017
Practice Address - Fax:706-925-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-12
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health