Healthcare Provider Details

I. General information

NPI: 1013418995
Provider Name (Legal Business Name): HEART FOR CHANGE CHILDREN AND FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N DUKE ST
LANCASTER PA
17602-4915
US

IV. Provider business mailing address

325 N DUKE ST
LANCASTER PA
17602-4915
US

V. Phone/Fax

Practice location:
  • Phone: 717-696-5758
  • Fax:
Mailing address:
  • Phone: 717-696-5758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberSW127553
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StatePA

VIII. Authorized Official

Name: MELISSA SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential: LSW
Phone: 717-696-5758