Provider Demographics
NPI:1265919054
Name:HEART TWO HEART REHAB SUPPORT SERVICES
Entity type:Organization
Organization Name:HEART TWO HEART REHAB SUPPORT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:ROSHELLE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MS QMHP-A
Authorized Official - Phone:276-618-4605
Mailing Address - Street 1:PO BOX 3542
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24115-3542
Mailing Address - Country:US
Mailing Address - Phone:276-790-3341
Mailing Address - Fax:276-790-3167
Practice Address - Street 1:916 BROOKDALE ST STE 2
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3105
Practice Address - Country:US
Practice Address - Phone:276-790-3341
Practice Address - Fax:276-790-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)