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General NPI Number Information
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NPI Number | 1083237630
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Entity Type | Organization
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Legal Business Name | THE HEART PROGRAM
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 224 S ELM DR
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City | PAYSON
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State | AZ
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Zip | 85541-2068
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Country | US
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Telephone | 602-762-3222
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Fax |
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Provider Business Mailing Address
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Address Line | 224 S ELM DR
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City | PAYSON
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State | AZ
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Zip | 85541-2068
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Country | US
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Telephone | 602-762-3222
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Fax |
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Authorized Official
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Title or Position | MEMBER AND MANAGER
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Name | ABIGAIL SASSANO
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Credential |
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Telephone | 602-762-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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