Provider Demographics
NPI:1790046571
Name:HEADS HELD HIGH, INC.
Entity Type:Organization
Organization Name:HEADS HELD HIGH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:917-763-3438
Mailing Address - Street 1:116 WAINWRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2032
Mailing Address - Country:US
Mailing Address - Phone:917-763-3438
Mailing Address - Fax:
Practice Address - Street 1:116 WAINWRIGHT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2032
Practice Address - Country:US
Practice Address - Phone:917-763-3438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty