Provider Demographics
NPI:1912304718
Name:ALL HEARTS HOMECARE, LLC
Entity Type:Organization
Organization Name:ALL HEARTS HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEZZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-213-2146
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-0623
Mailing Address - Country:US
Mailing Address - Phone:864-213-2146
Mailing Address - Fax:864-297-2515
Practice Address - Street 1:1200 WOODRUFF RD
Practice Address - Street 2:SUITE A3
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5730
Practice Address - Country:US
Practice Address - Phone:864-213-2146
Practice Address - Fax:864-297-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1389Medicaid