Provider Demographics
NPI:1528548245
Name:KINGS SERVING HEARTS INC
Entity Type:Organization
Organization Name:KINGS SERVING HEARTS INC
Other - Org Name:VISITING ANGELS JONESBORO GA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:LAURENCE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:CHC
Authorized Official - Phone:678-604-6406
Mailing Address - Street 1:3961 STONEBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7329
Mailing Address - Country:US
Mailing Address - Phone:678-896-6540
Mailing Address - Fax:
Practice Address - Street 1:198 N MCDONOUGH ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3665
Practice Address - Country:US
Practice Address - Phone:678-604-6406
Practice Address - Fax:678-604-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031-R-1832251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health