MEDICARE: HEARTS AND HOMES FOR YOUTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1417338070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTS AND HOMES FOR YOUTH, INC.

Provider Business Mailing Address
First Line	:	3919 NATIONAL DR STE 400
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1182
Country	:	US
Telephone Number	:	301-589-8444
Fax Number	:	301-495-0923

Provider Business Practice Location Address
First Line	:	3919 NATIONAL DR STE 400
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1182
Country	:	US
Telephone Number	:	301-589-8444
Fax Number	:	301-495-0923

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MS. CHLOE PEREZ
Credential	:	LCSW-C
Telephone Number	:	301-679-1381

Provider Enumeration Date	:	06/09/2015
Last Update Date	:	06/09/2015

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