MEDICARE: HEARTSHARE HUMAN SERVICES

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	251B00000X	Case Management Agency		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R48	OTHER	NY	MISN

General Provider Information

NPI Number	:	1528289642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTSHARE HUMAN SERVICES

Provider Business Mailing Address
First Line	:	2865 W 19TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2865 W 19TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2513
Country	:	US
Telephone Number	:	718-372-0580
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MARIA GOODWIN
Credential	:
Telephone Number	:	718-372-0580

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/21/2022

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