Healthcare Provider Details

I. General information

NPI: 1396575569
Provider Name (Legal Business Name): HEART OF PLAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 ELMHURST AVE
HUMBOLDT IA
50548-1882
US

IV. Provider business mailing address

1721 ELMHURST AVE
HUMBOLDT IA
50548-1882
US

V. Phone/Fax

Practice location:
  • Phone: 515-450-2583
  • Fax: 515-420-8303
Mailing address:
  • Phone: 515-450-2583
  • Fax: 515-420-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NOLAN M VITZTHUM
Title or Position: OWNER/THERAPIST
Credential: LISW
Phone: 515-450-2583