Provider Demographics
NPI:1205646346
Name:OPEN HEARTS
Entity type:Organization
Organization Name:OPEN HEARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-285-5550
Mailing Address - Street 1:3280 S COUNTRY CLUB WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4065
Mailing Address - Country:US
Mailing Address - Phone:022-855-5550
Mailing Address - Fax:
Practice Address - Street 1:3280 S COUNTRY CLUB WAY STE 110
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4065
Practice Address - Country:US
Practice Address - Phone:022-855-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty