Healthcare Provider Details

I. General information

NPI: 1184533796
Provider Name (Legal Business Name): HEARTIVIA CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13412 225TH ST
LAURELTON NY
11413-2039
US

IV. Provider business mailing address

13412 225TH ST
LAURELTON NY
11413-2039
US

V. Phone/Fax

Practice location:
  • Phone: 929-310-5651
  • Fax: 929-529-6056
Mailing address:
  • Phone: 929-310-5651
  • Fax: 929-529-6056

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DAMOYA T HALL -REID
Title or Position: EXECUTIVE DIRECTOR.
Credential:
Phone: 929-310-5651