1801623228 NPI number — HEALING HARTZE, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801623228 NPI number — HEALING HARTZE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALING HARTZE, PLLC
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:
1801623228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17505 N 79TH AVE STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85308-8724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-292-4477
Provider Business Mailing Address Fax Number:
602-900-0969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23460 N 19TH AVE STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85027-2170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-989-8899
Provider Business Practice Location Address Fax Number:
602-900-0969
Provider Enumeration Date:
09/18/2024

Additional Information

Authorized Official

Authorized Official Last Name:
HARTZE
Authorized Official First Name:
JANUARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
602-292-4477

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1043982747 . This is a "HEALING HARTZE OTHER ORGANIZATIONAL NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: CSLG13337 . This is a "ARIZONA DEPARTMENT OF HEALTH SERVICES LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1740851542 . This is a "JANUARY HARTZE INDIVIDUAL NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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