Healthcare Provider Details

I. General information

NPI: 1649088147
Provider Name (Legal Business Name): CONNECTED HEARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10548 E MERCURY DR
APACHE JUNCTION AZ
85120-4255
US

IV. Provider business mailing address

10548 E MERCURY DR
APACHE JUNCTION AZ
85120-4255
US

V. Phone/Fax

Practice location:
  • Phone: 952-652-3289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KAYSIN BIRIK
Title or Position: ADMINISTRATOR
Credential:
Phone: 952-652-3289