Provider Demographics
NPI:1598264020
Name:VICARIOUS HEARTS, LLC
Entity Type:Organization
Organization Name:VICARIOUS HEARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-672-7494
Mailing Address - Street 1:424 SOUTHLAND TRL
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-6067
Mailing Address - Country:US
Mailing Address - Phone:833-384-3278
Mailing Address - Fax:478-246-0929
Practice Address - Street 1:424 SOUTHLAND TRL
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6067
Practice Address - Country:US
Practice Address - Phone:833-384-3278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health