Healthcare Provider Details

I. General information

NPI: 1841540796
Provider Name (Legal Business Name): H.E.A.R.T.S. FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 PONDEROSA DR
EVERGREEN CO
80439-4825
US

IV. Provider business mailing address

353 PONDEROSA DR
EVERGREEN CO
80439-4825
US

V. Phone/Fax

Practice location:
  • Phone: 303-358-2592
  • Fax:
Mailing address:
  • Phone: 303-358-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MARGARET DECKER BERRY
Title or Position: EXEC. DIRECTOR
Credential: MBA
Phone: 303-358-2592