Provider Demographics
NPI:1952504862
Name:GEORGE E. KELLEY DBA HEART TO HOME
Entity Type:Organization
Organization Name:GEORGE E. KELLEY DBA HEART TO HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DELFINA
Authorized Official - Middle Name:O
Authorized Official - Last Name:AMAYA
Authorized Official - Suffix:
Authorized Official - Credentials:BAAS
Authorized Official - Phone:210-499-5451
Mailing Address - Street 1:3246 SWANDALE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4404
Mailing Address - Country:US
Mailing Address - Phone:210-499-5451
Mailing Address - Fax:
Practice Address - Street 1:3246 SWANDALE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4404
Practice Address - Country:US
Practice Address - Phone:210-499-5451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities