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General NPI Number Information
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NPI Number | 1831391853
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Entity Type | Organization
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Legal Business Name | MENDING HEARTS
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 95 FIELDS CLF
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City | WHITESBURG
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State | KY
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Zip | 41858-7338
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Country | US
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Telephone | 606-633-1126
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Fax | 606-633-1126
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Provider Business Mailing Address
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Address Line | 95 FIELDS CLF
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City | WHITESBURG
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State | KY
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Zip | 41858-7338
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Country | US
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Telephone | 606-633-1126
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Fax | 606-633-1126
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Authorized Official
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Title or Position | OWNER
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Name | OLLIE M ADAMS
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Credential |
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Telephone | 606-633-1126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State | KY
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