Healthcare Provider Details

I. General information

NPI: 1750184032
Provider Name (Legal Business Name): HEARTWISE IDD SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 S 143RD PLZ
OMAHA NE
68144-5611
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 402-266-6667
  • Fax:
Mailing address:
  • Phone: 718-500-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARIAH HOPKINS
Title or Position: COMPLIANCE OFFICER
Credential: CHC
Phone: 402-266-6667