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General NPI Number Information
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NPI Number | 1730731910
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Entity Type | Organization
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Legal Business Name | PUZZLED HEARTS LLC
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Dates
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Enumeration Date | 07/09/2019
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 10001 VILLAGE GREEN DR STE B
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City | WOODSTOCK
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State | MD
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Zip | 21163-1148
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Country | US
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Telephone | 443-859-0332
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Fax |
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Provider Business Mailing Address
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Address Line | 10001 VILLAGE GREEN DR STE B
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City | WOODSTOCK
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State | MD
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Zip | 21163-1148
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Country | US
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Telephone | 443-859-0332
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TANIS HAWKINS
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Credential |
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Telephone | 443-859-0332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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