Provider Demographics
NPI:1497521215
Name:HEARTFELT HAVEN SERVICES LLC
Entity Type:Organization
Organization Name:HEARTFELT HAVEN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DORLIAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-345-9350
Mailing Address - Street 1:2713 CIDER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-9589
Mailing Address - Country:US
Mailing Address - Phone:980-345-9350
Mailing Address - Fax:
Practice Address - Street 1:2713 CIDER RIDGE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-9589
Practice Address - Country:US
Practice Address - Phone:980-345-9350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children