Healthcare Provider Details

I. General information

NPI: 1730935180
Provider Name (Legal Business Name): HEARTWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 WILLOW WAY
SANTA FE NM
87507-9156
US

IV. Provider business mailing address

1061 WILLOW WAY
SANTA FE NM
87507-9156
US

V. Phone/Fax

Practice location:
  • Phone: 765-748-6139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DEREK RUGSAKEN
Title or Position: OWNER
Credential:
Phone: 765-748-6139