Provider Demographics
NPI:1790350411
Name:MANA HRT, LLC
Entity Type:Organization
Organization Name:MANA HRT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-410-3804
Mailing Address - Street 1:736 W STATE ST APT G202
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-4453
Mailing Address - Country:US
Mailing Address - Phone:801-410-3804
Mailing Address - Fax:
Practice Address - Street 1:736 W STATE ST APT G202
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-4453
Practice Address - Country:US
Practice Address - Phone:801-410-3804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center