Provider Demographics
NPI:1144569039
Name:HEARTS & MINDS ACTIVITY CENTER
Entity Type:Organization
Organization Name:HEARTS & MINDS ACTIVITY CENTER
Other - Org Name:RESPITE AND RESEARCH FOR ALZHEIMERS DISEASE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANGELICA
Authorized Official - Last Name:NICOLACOUDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:408-279-7515
Mailing Address - Street 1:2380 ENBERG LANE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2146
Mailing Address - Country:US
Mailing Address - Phone:408-279-7515
Mailing Address - Fax:408-279-7519
Practice Address - Street 1:2380 ENBERG LANE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2146
Practice Address - Country:US
Practice Address - Phone:408-279-7515
Practice Address - Fax:408-279-7519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435202011261QA0600X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care