Healthcare Provider Details

I. General information

NPI: 1760386692
Provider Name (Legal Business Name): HOUSE OF HEARTS MICHIGAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E EISENHOWER PKWY STE 300
ANN ARBOR MI
48108-3324
US

IV. Provider business mailing address

4974 SARAZEN DR
HOLLYWOOD FL
33021-2266
US

V. Phone/Fax

Practice location:
  • Phone: 347-906-1234
  • Fax: 305-703-4994
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: NOAH JOSEPH GOLDSTEIN
Title or Position: FOUNDER & CEO
Credential:
Phone: 347-906-1234