Healthcare Provider Details

I. General information

NPI: 1083215784
Provider Name (Legal Business Name): BETWEEN HEARTBEATS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 LLOYD LN
NORTH AURORA IL
60542-9088
US

IV. Provider business mailing address

703 LLOYD LN
NORTH AURORA IL
60542-9088
US

V. Phone/Fax

Practice location:
  • Phone: 630-423-6514
  • Fax:
Mailing address:
  • Phone: 773-816-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOMINIKA VENTUCCI
Title or Position: CEO/FOUNDER
Credential: LCSW
Phone: 773-816-9804