Provider Demographics
NPI:1922785203
Name:HEART OF A QUEEN HOMECARE SERVICES, LLC
Entity Type:Organization
Organization Name:HEART OF A QUEEN HOMECARE SERVICES, LLC
Other - Org Name:HEART OF A QUEEN HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLEBEAUX-QUARLES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:864-962-3635
Mailing Address - Street 1:503 S MAIN ST STE 6025
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2204
Mailing Address - Country:US
Mailing Address - Phone:864-962-3635
Mailing Address - Fax:864-900-0991
Practice Address - Street 1:503 S MAIN ST STE 6025
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2204
Practice Address - Country:US
Practice Address - Phone:864-962-3635
Practice Address - Fax:864-900-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty