Healthcare Provider Details

I. General information

NPI: 1811710387
Provider Name (Legal Business Name): HEARTWISE MISSOURI ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 BLUE RIDGE BLVD STE 611B
KANSAS CITY MO
64133-1721
US

IV. Provider business mailing address

4403 15TH AVE STE 499
BROOKLYN NY
11219-1604
US

V. Phone/Fax

Practice location:
  • Phone: 718-400-9077
  • Fax:
Mailing address:
  • Phone: 718-400-9077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ZALMEN LOVI
Title or Position: CEO
Credential:
Phone: 718-400-9077