Provider Demographics
NPI:1760045132
Name:MENDED HEART LLC
Entity Type:Organization
Organization Name:MENDED HEART LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLEDGER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LSW
Authorized Official - Phone:216-543-5632
Mailing Address - Street 1:17760 S MEADOWPARK DR
Mailing Address - Street 2:
Mailing Address - City:WALTON HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-5153
Mailing Address - Country:US
Mailing Address - Phone:216-543-5632
Mailing Address - Fax:
Practice Address - Street 1:17760 S MEADOWPARK DR
Practice Address - Street 2:
Practice Address - City:WALTON HILLS
Practice Address - State:OH
Practice Address - Zip Code:44146-5153
Practice Address - Country:US
Practice Address - Phone:216-543-5632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-20
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty