1336846864 NPI number — SENSITIVE HEART HEALTH TRAINING AGENCY, LLC

Table of content: (NPI 1336846864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336846864 NPI number — SENSITIVE HEART HEALTH TRAINING AGENCY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENSITIVE HEART HEALTH TRAINING AGENCY, 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:
1336846864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4602 WESTGROVE CT.
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23455-5414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-904-5611
Provider Business Mailing Address Fax Number:
757-904-5612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4602 WESTGROVE CT.
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23455-5414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-904-5611
Provider Business Practice Location Address Fax Number:
757-904-5612
Provider Enumeration Date:
02/15/2023

Additional Information

Authorized Official

Authorized Official Last Name:
HAYES
Authorized Official First Name:
DORINA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
757-904-5611

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HCO233050 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001172911 . This is a "RN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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