Provider Demographics
NPI:1760067102
Name:WILLING HEARTS COMMUNITY CARE, LLC.
Entity Type:Organization
Organization Name:WILLING HEARTS COMMUNITY CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOULARS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:973-277-3204
Mailing Address - Street 1:10 N END TER
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4404
Mailing Address - Country:US
Mailing Address - Phone:973-277-3204
Mailing Address - Fax:
Practice Address - Street 1:10 N END TER
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4404
Practice Address - Country:US
Practice Address - Phone:973-277-3204
Practice Address - Fax:866-441-0913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities