Healthcare Provider Details

I. General information

NPI: 1194410530
Provider Name (Legal Business Name): HEARTLINKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W 2ND ST
GRANDVIEW WA
98930-1361
US

IV. Provider business mailing address

204 W 2ND ST
GRANDVIEW WA
98930-1361
US

V. Phone/Fax

Practice location:
  • Phone: 509-837-1676
  • Fax: 509-837-1990
Mailing address:
  • Phone: 509-837-1676
  • Fax: 509-837-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHELBY ELAINE MOORE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 509-837-1676