Provider Demographics
NPI:1659015238
Name:HAWKINS HEART IN-HOMECARE, INC.
Entity Type:Organization
Organization Name:HAWKINS HEART IN-HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DESSERITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DYSON
Authorized Official - Suffix:
Authorized Official - Credentials:DESSERITA DYSON
Authorized Official - Phone:229-216-0134
Mailing Address - Street 1:PO BOX 2911
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-2911
Mailing Address - Country:US
Mailing Address - Phone:229-216-0134
Mailing Address - Fax:
Practice Address - Street 1:216 1ST AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6511
Practice Address - Country:US
Practice Address - Phone:229-216-0134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care