Provider Demographics
NPI:1902282296
Name:HEART 2 HEART HOME CARE, INC.
Entity Type:Organization
Organization Name:HEART 2 HEART HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:678-814-9007
Mailing Address - Street 1:200 RUSSELL ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-1815
Mailing Address - Country:US
Mailing Address - Phone:219-501-7015
Mailing Address - Fax:219-501-7030
Practice Address - Street 1:200 RUSSELL ST STE 301
Practice Address - Street 2:SUITE 201
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1825
Practice Address - Country:US
Practice Address - Phone:219-501-7015
Practice Address - Fax:219-501-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000435253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000895452CMedicaid
GA111764Medicare UPIN