Provider Demographics
NPI:1629422050
Name:HEARTS & HANDS CLA, LLC
Entity Type:Organization
Organization Name:HEARTS & HANDS CLA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANADA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOZIER YORK
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:843-372-0745
Mailing Address - Street 1:8402 ROSWELL RD
Mailing Address - Street 2:APT C
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-7826
Mailing Address - Country:US
Mailing Address - Phone:843-372-0745
Mailing Address - Fax:404-393-3821
Practice Address - Street 1:1382 FULTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-2218
Practice Address - Country:US
Practice Address - Phone:843-372-0745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA057875607OtherDRIVER'S LICENSE
SCIHCP0528OtherDHEC PERMIT