1538935721 NPI number — HEARTHSTONE THERAPY SERVICES LLC.

Table of content: SARAH COVARRUBIAS CID LPT (NPI 1790275501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538935721 NPI number — HEARTHSTONE THERAPY SERVICES LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTHSTONE THERAPY SERVICES LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538935721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 S 5TH ST # 313
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADRAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97741-1352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-675-8002
Provider Business Mailing Address Fax Number:
541-460-5593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 NW BIRCH LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADRAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97741-9082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-675-8002
Provider Business Practice Location Address Fax Number:
541-460-5593
Provider Enumeration Date:
11/28/2023

Additional Information

Authorized Official

Authorized Official Last Name:
DAWKINS
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
FAY
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
541-675-8002

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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