1033622436 NPI number — HEARTWOOD CENTER FOR CHILD AND FAMILY THERAPY, LLC

Table of content: (NPI 1033622436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033622436 NPI number — HEARTWOOD CENTER FOR CHILD AND FAMILY THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTWOOD CENTER FOR CHILD AND FAMILY THERAPY, 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:
1033622436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 E HOWARD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIBBING
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55746-1736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-263-1347
Provider Business Mailing Address Fax Number:
218-263-3241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 E HOWARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIBBING
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55746-1736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-263-1347
Provider Business Practice Location Address Fax Number:
218-263-3241
Provider Enumeration Date:
11/08/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KENDALL
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
218-263-1347

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  2825 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: 21152 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 2825 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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