Provider Demographics
NPI:1093141517
Name:HEART TO HEART RESIDENTIAL SERVICES LLC
Entity Type:Organization
Organization Name:HEART TO HEART RESIDENTIAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES-CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-833-0873
Mailing Address - Street 1:6012 MOONLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-4620
Mailing Address - Country:US
Mailing Address - Phone:804-833-0873
Mailing Address - Fax:
Practice Address - Street 1:2115 N WHITEHILL DR
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3731
Practice Address - Country:US
Practice Address - Phone:804-833-0873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1821-01-001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities