Provider Demographics
NPI:1669187555
Name:HEARTWOOD HOUSE LLC
Entity type:Organization
Organization Name:HEARTWOOD HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-867-7143
Mailing Address - Street 1:8 CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3821
Mailing Address - Country:US
Mailing Address - Phone:415-419-8816
Mailing Address - Fax:
Practice Address - Street 1:771 ROWLAND BLVD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4647
Practice Address - Country:US
Practice Address - Phone:415-419-8816
Practice Address - Fax:415-651-4459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTWOOD HOUSE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility