Provider Demographics
NPI:1386323699
Name:AMAZING HEARTS HOMECARE LLC
Entity type:Organization
Organization Name:AMAZING HEARTS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KORPO
Authorized Official - Middle Name:KPISSAY
Authorized Official - Last Name:ERAWOC
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:404-447-7927
Mailing Address - Street 1:1418 MILL POINTE CT # B
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-9111
Mailing Address - Country:US
Mailing Address - Phone:404-447-7927
Mailing Address - Fax:
Practice Address - Street 1:1418 MILL POINTE CT # B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-9111
Practice Address - Country:US
Practice Address - Phone:404-447-7927
Practice Address - Fax:678-407-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care