Healthcare Provider Details

I. General information

NPI: 1891046488
Provider Name (Legal Business Name): HAPPY HEART HEALTH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 MAIN ST SUITE 105
AUBURN ME
04210-5883
US

IV. Provider business mailing address

81 MAIN ST SUITE 105
AUBURN ME
04210-5883
US

V. Phone/Fax

Practice location:
  • Phone: 207-653-0776
  • Fax:
Mailing address:
  • Phone: 207-653-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLC9716
License Number StateME

VIII. Authorized Official

Name: EILEEN MANGLASS
Title or Position: PRESIDENT
Credential: LCSW
Phone: 207-653-0776