Provider Demographics
NPI:1710594155
Name:HEARTWOOD CENTER, LLC
Entity Type:Organization
Organization Name:HEARTWOOD CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYNEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MN, PMHNP-BC, CNM
Authorized Official - Phone:503-427-8581
Mailing Address - Street 1:14350 SW HIDDEN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8347
Mailing Address - Country:US
Mailing Address - Phone:503-427-8581
Mailing Address - Fax:503-461-0061
Practice Address - Street 1:200 E 2ND ST STE 102
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3083
Practice Address - Country:US
Practice Address - Phone:503-427-8581
Practice Address - Fax:503-461-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty