Provider Demographics
NPI:1598302028
Name:HEARN HOUSE 2 LLC
Entity Type:Organization
Organization Name:HEARN HOUSE 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOULAIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-736-0522
Mailing Address - Street 1:5520 N 71ST AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-5324
Mailing Address - Country:US
Mailing Address - Phone:623-215-7563
Mailing Address - Fax:
Practice Address - Street 1:8793 W MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-2469
Practice Address - Country:US
Practice Address - Phone:602-736-0522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities