Provider Demographics
NPI:1780889022
Name:KINDRED HEARTS ADULT CARE HOME
Entity type:Organization
Organization Name:KINDRED HEARTS ADULT CARE HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTED LIVING ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VELMA
Authorized Official - Middle Name:HINES
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-722-6916
Mailing Address - Street 1:3171 CARVER SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-4750
Mailing Address - Country:US
Mailing Address - Phone:336-722-6919
Mailing Address - Fax:336-703-9086
Practice Address - Street 1:3171 CARVER SCHOOL RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-4750
Practice Address - Country:US
Practice Address - Phone:336-722-6919
Practice Address - Fax:336-703-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-034-064311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home