Provider Demographics
NPI:1437504651
Name:HEARTS WITH A MISSION
Entity Type:Organization
Organization Name:HEARTS WITH A MISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-646-7385
Mailing Address - Street 1:521 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-5852
Mailing Address - Country:US
Mailing Address - Phone:541-646-7385
Mailing Address - Fax:541-732-4833
Practice Address - Street 1:711 MEDFORD CTR # 334
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6772
Practice Address - Country:US
Practice Address - Phone:541-646-7385
Practice Address - Fax:541-732-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health