Healthcare Provider Details

I. General information

NPI: 1922582907
Provider Name (Legal Business Name): UNITED HEARTS BEHAVIORAL HEALTH LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5832 HARRIER LN
ATLANTA GA
30349-8871
US

IV. Provider business mailing address

1725 KIM WATT DR APT 13
KNOXVILLE TN
37909-1446
US

V. Phone/Fax

Practice location:
  • Phone: 910-670-1346
  • Fax:
Mailing address:
  • Phone: 910-670-1346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ULLYSSIA RENEE' RICHARDSON
Title or Position: PRESIDENT
Credential:
Phone: 910-670-1346