Provider Demographics
NPI:1356860613
Name:MENDING HEARTS MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:MENDING HEARTS MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-926-2373
Mailing Address - Street 1:781 PETREE FARM LN
Mailing Address - Street 2:
Mailing Address - City:RURAL HALL
Mailing Address - State:NC
Mailing Address - Zip Code:27045-9895
Mailing Address - Country:US
Mailing Address - Phone:336-969-9865
Mailing Address - Fax:336-969-9865
Practice Address - Street 1:781 PETREE FARM LANE
Practice Address - Street 2:
Practice Address - City:RURAL HALL
Practice Address - State:NC
Practice Address - Zip Code:27045
Practice Address - Country:US
Practice Address - Phone:336-969-9865
Practice Address - Fax:336-969-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies