Healthcare Provider Details

I. General information

NPI: 1730731910
Provider Name (Legal Business Name): PUZZLED HEARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 VILLAGE GREEN DR STE B
WOODSTOCK MD
21163-1148
US

IV. Provider business mailing address

10001 VILLAGE GREEN DR STE B
WOODSTOCK MD
21163-1148
US

V. Phone/Fax

Practice location:
  • Phone: 443-859-0332
  • Fax:
Mailing address:
  • Phone: 443-859-0332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. TANIS HAWKINS
Title or Position: PRESIDENT
Credential:
Phone: 443-859-0332