Organization
HEART TO HEART PERSONAL CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARDA NICOLE JOHNSON (CEO)
(662) 402-6452
Entity
Organization
Contact information
Practice address
800 MISSISSIPPI STREET, SHELBY, MS 38774
(662) 398-7133
(662) 775-5018
Mailing address
PO BOX 1026, SHELBY, MS 38774-1026
(662) 402-7133
(662) 775-5018
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000254505
—
MS
05
—
007821551
—
MS
Enumeration date
10/06/2022
Last updated
10/06/2022
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