Provider Demographics
NPI:1710454285
Name:HART COMMUNITY HOMES
Entity Type:Organization
Organization Name:HART COMMUNITY HOMES
Other - Org Name:CYS HART COMMUNITY HOMES BRADY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HART-BUNIVETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-526-2729
Mailing Address - Street 1:24872 LUNA BONITA DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5643
Mailing Address - Country:US
Mailing Address - Phone:949-680-9529
Mailing Address - Fax:
Practice Address - Street 1:1119 E CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-3505
Practice Address - Country:US
Practice Address - Phone:949-680-9529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty