Provider Demographics
NPI:1750181087
Name:HEARTYHAVEN-ENTERPRISE LLC
Entity type:Organization
Organization Name:HEARTYHAVEN-ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IEASHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CRAMARTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-464-8484
Mailing Address - Street 1:35 DORLAND AVE SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-5111
Mailing Address - Country:US
Mailing Address - Phone:845-464-8484
Mailing Address - Fax:
Practice Address - Street 1:35 DORLAND AVE SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5111
Practice Address - Country:US
Practice Address - Phone:845-464-8484
Practice Address - Fax:845-464-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health