Provider Demographics
NPI:1770104762
Name:CLEAN HANDS PURE HEART
Entity type:Organization
Organization Name:CLEAN HANDS PURE HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERA
Authorized Official - Middle Name:TAHMARA
Authorized Official - Last Name:DIGGS BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-865-8693
Mailing Address - Street 1:4724 GRASSET AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4025
Mailing Address - Country:US
Mailing Address - Phone:980-875-8693
Mailing Address - Fax:
Practice Address - Street 1:4724 GRASSET AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-4025
Practice Address - Country:US
Practice Address - Phone:980-875-8693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3892146OtherDRIVERS LICENSE