Healthcare Provider Details

I. General information

NPI: 1710594155
Provider Name (Legal Business Name): HEARTWOOD CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 2ND ST STE 102
NEWBERG OR
97132-3083
US

IV. Provider business mailing address

14350 SW HIDDEN HILLS RD
MCMINNVILLE OR
97128-8347
US

V. Phone/Fax

Practice location:
  • Phone: 503-427-8581
  • Fax: 503-461-0061
Mailing address:
  • Phone: 503-427-8581
  • Fax: 503-461-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA RYNEARSON
Title or Position: OWNER, CLINICIAN
Credential: MN, PMHNP-BC, CNM
Phone: 503-427-8581