1376676684 NPI number — HEALING HEARTS OF TN, INC

Table of content: (NPI 1376676684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376676684 NPI number — HEALING HEARTS OF TN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALING HEARTS OF TN, INC
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:
1376676684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 E MORFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC MINNVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37110-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-474-4763
Provider Business Mailing Address Fax Number:
931-474-4764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 E MORFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC MINNVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37110-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-474-4763
Provider Business Practice Location Address Fax Number:
931-474-4764
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
931-474-4673

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 457801 . This is a "VALUE OPTIONS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: $$$$$$$$$ . This is a "SOCIAL SECURITY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7239269 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4094346 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: $$$$$$$$$ . This is a "SOCIAL SECURITY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 40999839 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2072152 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4080157 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: $$$$$$$$$ . This is a "SOCIAL SECURITY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com