Provider Demographics
NPI:1669097853
Name:HEARTFELT HOMES OF THE CAROLINAS LLC
Entity type:Organization
Organization Name:HEARTFELT HOMES OF THE CAROLINAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEDIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TABORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-965-3841
Mailing Address - Street 1:7028 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4017
Mailing Address - Country:US
Mailing Address - Phone:704-965-3841
Mailing Address - Fax:
Practice Address - Street 1:440 CHARLES ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677
Practice Address - Country:US
Practice Address - Phone:704-257-1086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency