Provider Demographics
NPI:1467988121
Name:PURE HEART COMMUNITY SERVICES INC
Entity Type:Organization
Organization Name:PURE HEART COMMUNITY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KISELEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-934-0427
Mailing Address - Street 1:5210 WINDWARD LN
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4061
Mailing Address - Country:US
Mailing Address - Phone:267-934-0427
Mailing Address - Fax:
Practice Address - Street 1:5210 WINDWARD LN
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4061
Practice Address - Country:US
Practice Address - Phone:267-934-0427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health