Healthcare Provider Details

I. General information

NPI: 1932304573
Provider Name (Legal Business Name): HEARTWOOD HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6114 LA SALLE AVE # 221
OAKLAND CA
94611-2802
US

IV. Provider business mailing address

6114 LA SALLE AVE # 221
OAKLAND CA
94611-2802
US

V. Phone/Fax

Practice location:
  • Phone: 510-339-1513
  • Fax:
Mailing address:
  • Phone: 510-339-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberG308288
License Number StateCA

VIII. Authorized Official

Name: MICHELLE V GILMORE
Title or Position: PRESIDENT
Credential: RN,MSN,NP
Phone: 510-339-1513