Provider Demographics
NPI:1649841198
Name:HEART TO HEART HOME CARE ASSISTANCE
Entity type:Organization
Organization Name:HEART TO HEART HOME CARE ASSISTANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:OLANDIS
Authorized Official - Last Name:SCALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-226-2001
Mailing Address - Street 1:142 BENGE DR
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-8722
Mailing Address - Country:US
Mailing Address - Phone:919-344-6971
Mailing Address - Fax:
Practice Address - Street 1:11104 PENDERWOOD CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8573
Practice Address - Country:US
Practice Address - Phone:252-226-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1649841198Medicaid