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General NPI Number Information
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NPI Number | 1710594155
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Entity Type | Organization
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Legal Business Name | HEARTWOOD CENTER, LLC
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 200 E 2ND ST STE 102
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City | NEWBERG
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State | OR
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Zip | 97132-3083
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Country | US
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Telephone | 503-427-8581
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Fax | 503-461-0061
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Provider Business Mailing Address
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Address Line | 14350 SW HIDDEN HILLS RD
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City | MCMINNVILLE
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State | OR
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Zip | 97128-8347
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Country | US
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Telephone | 503-427-8581
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Fax | 503-461-0061
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Authorized Official
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Title or Position | OWNER, CLINICIAN
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Name | SAMANTHA RYNEARSON
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Credential | MN, PMHNP-BC, CNM
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Telephone | 503-427-8581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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