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General NPI Number Information
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NPI Number | 1184533796
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Entity Type | Organization
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Legal Business Name | HEARTIVIA CARE
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 13412 225TH ST
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City | LAURELTON
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State | NY
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Zip | 11413-2039
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Country | US
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Telephone | 929-310-5651
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Fax | 929-529-6056
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Provider Business Mailing Address
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Address Line | 13412 225TH ST
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City | LAURELTON
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State | NY
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Zip | 11413-2039
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Country | US
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Telephone | 929-310-5651
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Fax | 929-529-6056
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR.
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Name | DAMOYA T HALL -REID
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Credential |
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Telephone | 929-310-5651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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