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General NPI Number Information
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NPI Number | 1801547146
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Entity Type | Organization
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Legal Business Name | HEART-ACTIVE LLC
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 1323 BROADWAY ST
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City | LITTLE ROCK
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State | AR
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Zip | 72202-4843
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Country | US
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Telephone | 501-580-3335
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Fax |
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Provider Business Mailing Address
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Address Line | 1323 BROADWAY ST
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City | LITTLE ROCK
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State | AR
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Zip | 72202-4843
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INCORPORATOR/ORGANIZER
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Name | RUTH L EUDY
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Credential | PHD
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Telephone | 501-580-3335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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