Provider Demographics
NPI:1568696607
Name:PURE AT HEART INC
Entity Type:Organization
Organization Name:PURE AT HEART INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-647-7474
Mailing Address - Street 1:326 E WEBER ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-3160
Mailing Address - Country:US
Mailing Address - Phone:225-647-7474
Mailing Address - Fax:225-450-6427
Practice Address - Street 1:326 E WEBER ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3160
Practice Address - Country:US
Practice Address - Phone:225-647-7474
Practice Address - Fax:225-450-6427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)