Provider Demographics
NPI:1689208605
Name:GEPPETTO'S HEART
Entity Type:Organization
Organization Name:GEPPETTO'S HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELVIE
Authorized Official - Middle Name:TORA
Authorized Official - Last Name:BERKERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-595-5772
Mailing Address - Street 1:24555 SOUTHFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2788
Mailing Address - Country:US
Mailing Address - Phone:248-809-3795
Mailing Address - Fax:248-327-4286
Practice Address - Street 1:24555 SOUTHFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2788
Practice Address - Country:US
Practice Address - Phone:248-809-3795
Practice Address - Fax:248-327-4286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health