Provider Demographics
NPI:1558726596
Name:HEART TO HEART PCS AGENCY
Entity Type:Organization
Organization Name:HEART TO HEART PCS AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-756-5918
Mailing Address - Street 1:6814 CRUMPLER BLVD # 201-D
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1905
Mailing Address - Country:US
Mailing Address - Phone:662-932-2147
Mailing Address - Fax:662-932-2148
Practice Address - Street 1:6814 CRUMPLER BLVD # 201-D
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-1905
Practice Address - Country:US
Practice Address - Phone:662-932-2147
Practice Address - Fax:662-932-2148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25100000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health