Provider Demographics
NPI:1932604436
Name:AFFILIATED HEART2HEART HOMECARE SERVICES, INC.
Entity Type:Organization
Organization Name:AFFILIATED HEART2HEART HOMECARE SERVICES, INC.
Other - Org Name:INFINITY HEALTHCARE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAWANNA
Authorized Official - Middle Name:TYRELLE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-752-6262
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-0854
Mailing Address - Country:US
Mailing Address - Phone:225-289-4848
Mailing Address - Fax:225-263-0033
Practice Address - Street 1:656 LOBDELL AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6318
Practice Address - Country:US
Practice Address - Phone:225-289-4848
Practice Address - Fax:225-263-0033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFILIATED HEART2HEART HOMECARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-27
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203783621251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LABH0012212Medicaid