Healthcare Provider Details

I. General information

NPI: 1003132168
Provider Name (Legal Business Name): HEART TO HEART YOUTH AND ENRICHMENT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 FAIR HAVEN WAY
CHAPIN SC
29036-9239
US

IV. Provider business mailing address

187 FAIR HAVEN WAY
CHAPIN SC
29036-9239
US

V. Phone/Fax

Practice location:
  • Phone: 803-462-4570
  • Fax: 803-753-7335
Mailing address:
  • Phone: 803-462-4570
  • Fax: 803-753-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARONDA D GORDON
Title or Position: CEO
Credential:
Phone: 803-476-7292