Provider Demographics
NPI:1578097739
Name:HEART TO HEART PROFESSIONAL CARE INC.
Entity Type:Organization
Organization Name:HEART TO HEART PROFESSIONAL CARE INC.
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:754-264-5264
Mailing Address - Street 1:1930 NE 1ST TER
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-5006
Mailing Address - Country:US
Mailing Address - Phone:754-264-5264
Mailing Address - Fax:
Practice Address - Street 1:1930 NE 1ST TER
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-5006
Practice Address - Country:US
Practice Address - Phone:754-264-5264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232828251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1093107302Medicaid