Provider Demographics
NPI:1730480369
Name:CARING HEARTS PERSONAL HOME
Entity type:Organization
Organization Name:CARING HEARTS PERSONAL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-202-4271
Mailing Address - Street 1:261 MOUNT VERNON RD NW
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-5059
Mailing Address - Country:US
Mailing Address - Phone:770-207-9618
Mailing Address - Fax:770-207-9618
Practice Address - Street 1:261 MOUNT VERNON RD NW
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-5059
Practice Address - Country:US
Practice Address - Phone:770-207-9618
Practice Address - Fax:770-207-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA147010211261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care