Provider Demographics
NPI:1598205080
Name:THREE HEARTS ADT,LLC
Entity Type:Organization
Organization Name:THREE HEARTS ADT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YITZHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:FMD,BA,MA
Authorized Official - Phone:786-378-0909
Mailing Address - Street 1:2055 LEE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2055 LEE ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-2410
Practice Address - Country:US
Practice Address - Phone:786-378-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2017-CU-0123251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services