Provider Demographics
NPI:1467962605
Name:THE HEARTWOOD PROGRAM, LLC
Entity Type:Organization
Organization Name:THE HEARTWOOD PROGRAM, LLC
Other - Org Name:HEARTWOOD PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-970-4011
Mailing Address - Street 1:4350 EAST WEST HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4492
Mailing Address - Country:US
Mailing Address - Phone:301-970-4099
Mailing Address - Fax:301-970-4098
Practice Address - Street 1:4350 EAST WEST HWY STE 1025
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4520
Practice Address - Country:US
Practice Address - Phone:301-970-4099
Practice Address - Fax:301-970-4098
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHY FOUNDATIONS GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-02
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty