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General NPI Number Information
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NPI Number | 1669187555
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Entity Type | Organization
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Legal Business Name | HEARTWOOD HOUSE LLC
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 771 ROWLAND BLVD
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City | NOVATO
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State | CA
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Zip | 94947-4647
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Country | US
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Telephone | 415-419-8816
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Fax | 415-651-4459
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Provider Business Mailing Address
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Address Line | 8 CIRCLE RD
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City | SAN RAFAEL
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State | CA
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Zip | 94903-3821
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Country | US
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Telephone | 415-419-8816
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MICHAEL DEMPSEY
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Credential |
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Telephone | 415-867-7143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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