Healthcare Provider Details

I. General information

NPI: 1194890434
Provider Name (Legal Business Name): THE HEART CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 FRAN ST SE
SALEM OR
97306-1625
US

IV. Provider business mailing address

PO BOX 4125
SALEM OR
97302-8125
US

V. Phone/Fax

Practice location:
  • Phone: 503-585-8992
  • Fax: 503-304-0951
Mailing address:
  • Phone: 503-585-8992
  • Fax: 503-304-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number084053069RN
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number084053069N6 PMHNP-PP
License Number StateOR

VIII. Authorized Official

Name: MR. JAMES BEN NEWMAN
Title or Position: VICE PRESIDENT
Credential: MN, PMHNP
Phone: 503-585-8992