Provider Demographics
NPI:1720396294
Name:CARING HEART
Entity Type:Organization
Organization Name:CARING HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-557-5873
Mailing Address - Street 1:740 CONISBURGH CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4968
Mailing Address - Country:US
Mailing Address - Phone:678-557-5873
Mailing Address - Fax:770-413-4132
Practice Address - Street 1:740 CONISBURGH CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-4968
Practice Address - Country:US
Practice Address - Phone:678-557-5873
Practice Address - Fax:770-413-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-18
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAC681128305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service