Provider Demographics
NPI:1407049471
Name:HEARTHSTONE YOUTH AND FAMILY SERV
Entity Type:Organization
Organization Name:HEARTHSTONE YOUTH AND FAMILY SERV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-694-0906
Mailing Address - Street 1:474 NC HIGHWAY 62 S
Mailing Address - Street 2:
Mailing Address - City:YANCEYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27379-8504
Mailing Address - Country:US
Mailing Address - Phone:336-694-0906
Mailing Address - Fax:
Practice Address - Street 1:474 NC HIGHWAY 62 S
Practice Address - Street 2:
Practice Address - City:YANCEYVILLE
Practice Address - State:NC
Practice Address - Zip Code:27379-8504
Practice Address - Country:US
Practice Address - Phone:336-694-0906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300561GMedicaid