Provider Demographics
NPI:1407562374
Name:HEART SPACE HEALTH, INC.
Entity Type:Organization
Organization Name:HEART SPACE HEALTH, INC.
Other - Org Name:WITHIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KALUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-495-5048
Mailing Address - Street 1:612 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-5104
Mailing Address - Country:US
Mailing Address - Phone:737-226-2569
Mailing Address - Fax:
Practice Address - Street 1:612 W 22ND ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-5104
Practice Address - Country:US
Practice Address - Phone:737-226-2569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty