Healthcare Provider Details

I. General information

NPI: 1427383348
Provider Name (Legal Business Name): HEARTS MADE HAPPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 PAW PRINTS DR
CANON CITY CO
81212-8406
US

IV. Provider business mailing address

2915 PAW PRINTS DRIVE
CANON CITY CO
81212
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-0136
  • Fax:
Mailing address:
  • Phone: 719-275-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number88358
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number88358
License Number StateCO

VIII. Authorized Official

Name: MS. PATRICIA A. LAWRENCE
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 719-275-0136