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General NPI Number Information
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NPI Number | 1467962605
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Entity Type | Organization
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Legal Business Name | THE HEARTWOOD PROGRAM, LLC
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 4350 EAST WEST HWY STE 1025
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City | BETHESDA
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State | MD
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Zip | 20814-4520
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Country | US
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Telephone | 301-970-4099
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Fax | 301-970-4098
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Provider Business Mailing Address
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Address Line | 4350 EAST WEST HWY STE 201
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City | BETHESDA
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State | MD
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Zip | 20814-4492
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Country | US
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Telephone | 301-970-4099
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Fax | 301-970-4098
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. KURT KOCHES
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Credential |
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Telephone | 301-970-4011
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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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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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