MEDICARE: HEALING HEARTS SUPPORT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1528538675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING HEARTS SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	5660 E VIRGINIA BEACH BLVD STE 204
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-2468
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5660 E VIRGINIA BEACH BLVD STE 204
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-2468
Country	:	US
Telephone Number	:	757-309-7027
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NINA FRANKLIN
Credential	:
Telephone Number	:	757-309-7027

Provider Enumeration Date	:	12/03/2018
Last Update Date	:	12/03/2018

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