Healthcare Provider Details

I. General information

NPI: 1760045132
Provider Name (Legal Business Name): MENDED HEART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 08/20/2023
Certification Date: 08/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17760 S MEADOWPARK DR
WALTON HILLS OH
44146-5153
US

IV. Provider business mailing address

17760 S MEADOWPARK DR
WALTON HILLS OH
44146-5153
US

V. Phone/Fax

Practice location:
  • Phone: 216-543-5632
  • Fax:
Mailing address:
  • Phone: 216-543-5632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: KEISHA PLEDGER
Title or Position: OWNER
Credential: MSW LSW
Phone: 216-543-5632