Provider Demographics
NPI:1255418430
Name:HEARTLINKS
Entity type:Organization
Organization Name:HEARTLINKS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-837-1676
Mailing Address - Street 1:204 WEST 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930
Mailing Address - Country:US
Mailing Address - Phone:509-837-1676
Mailing Address - Fax:509-837-1990
Practice Address - Street 1:204 WEST 2ND STREET
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930
Practice Address - Country:US
Practice Address - Phone:509-837-1676
Practice Address - Fax:509-837-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS-369251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8026536Medicaid
WA8026536Medicaid