Provider Demographics
NPI:1922815091
Name:GOOD HEARTED HOME CARE
Entity type:Organization
Organization Name:GOOD HEARTED HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-498-1268
Mailing Address - Street 1:351 STONEGATE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3833
Mailing Address - Country:US
Mailing Address - Phone:646-498-1268
Mailing Address - Fax:
Practice Address - Street 1:615 W JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-4531
Practice Address - Country:US
Practice Address - Phone:646-498-1268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care