Provider Demographics
NPI:1952630287
Name:TENDER HEARTS HOMECARE SERVICES
Entity Type:Organization
Organization Name:TENDER HEARTS HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOLA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:CO-OWNER
Authorized Official - Phone:706-581-6822
Mailing Address - Street 1:P.O. BOX 42
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-2728
Mailing Address - Country:US
Mailing Address - Phone:706-517-3227
Mailing Address - Fax:
Practice Address - Street 1:734 RIDGE ST.
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2728
Practice Address - Country:US
Practice Address - Phone:706-517-3227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA105-R-0677253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care