Healthcare Provider Details

I. General information

NPI: 1942017496
Provider Name (Legal Business Name): THE HEALTHY HEART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 E SOUTHERN AVE STE 1
PHOENIX AZ
85040-3543
US

IV. Provider business mailing address

1522 E SOUTHERN AVE STE 1
PHOENIX AZ
85040-3543
US

V. Phone/Fax

Practice location:
  • Phone: 480-640-6047
  • Fax:
Mailing address:
  • Phone: 480-640-6047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AYANA HILL
Title or Position: OWNER
Credential:
Phone: 480-640-6047