Provider Demographics
NPI:1023579711
Name:OPEN HEARTS RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:OPEN HEARTS RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUITVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-547-0372
Mailing Address - Street 1:1426 KEMP BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5057
Mailing Address - Country:US
Mailing Address - Phone:757-232-7807
Mailing Address - Fax:757-436-3561
Practice Address - Street 1:1426 KEMP BRIDGE DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5057
Practice Address - Country:US
Practice Address - Phone:757-547-0372
Practice Address - Fax:757-436-3561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency