Provider Demographics
NPI:1518550086
Name:A NEW KIND HEART, LLC
Entity Type:Organization
Organization Name:A NEW KIND HEART, LLC
Other - Org Name:A NEW KIND HEART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:EDGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-377-0808
Mailing Address - Street 1:1132 VERSAILLES AVE.
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115
Mailing Address - Country:US
Mailing Address - Phone:469-377-0808
Mailing Address - Fax:214-884-8088
Practice Address - Street 1:1132 VERSAILLES AVE.
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:469-377-0808
Practice Address - Fax:214-884-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities