Provider Demographics
NPI:1659792422
Name:SACRED HEART HOME LLLP
Entity Type:Organization
Organization Name:SACRED HEART HOME LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:DACHA
Authorized Official - Last Name:PROSPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-561-0379
Mailing Address - Street 1:501 RUGBY CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-8645
Mailing Address - Country:US
Mailing Address - Phone:678-561-0379
Mailing Address - Fax:877-230-4123
Practice Address - Street 1:501 RUGBY CT
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-8645
Practice Address - Country:US
Practice Address - Phone:678-561-0379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRED HEART TRANSPORTATION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-22
Last Update Date:2013-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003132108AMedicaid