Provider Demographics
NPI:1710361829
Name:A HEARTBEAT AWAY
Entity Type:Organization
Organization Name:A HEARTBEAT AWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-333-1997
Mailing Address - Street 1:1416 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4247
Mailing Address - Country:US
Mailing Address - Phone:256-333-1997
Mailing Address - Fax:256-333-5007
Practice Address - Street 1:1416 6TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4247
Practice Address - Country:US
Practice Address - Phone:256-333-1997
Practice Address - Fax:256-333-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR009070220305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service