Provider Demographics
NPI:1912305186
Name:CARING HEARTS HOME CARE PROVIDER LLC
Entity Type:Organization
Organization Name:CARING HEARTS HOME CARE PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:870-358-3344
Mailing Address - Street 1:108 NATHAN ST
Mailing Address - Street 2:
Mailing Address - City:MARKED TREE
Mailing Address - State:AR
Mailing Address - Zip Code:72365-1448
Mailing Address - Country:US
Mailing Address - Phone:870-358-3344
Mailing Address - Fax:870-358-3349
Practice Address - Street 1:108 NATHAN ST
Practice Address - Street 2:
Practice Address - City:MARKED TREE
Practice Address - State:AR
Practice Address - Zip Code:72365-1448
Practice Address - Country:US
Practice Address - Phone:870-358-3344
Practice Address - Fax:870-358-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4749251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR187647752Medicaid
AR190260796Medicaid
AR190775797Medicaid
AR202863765Medicaid
AR189464732Medicaid