Provider Demographics
NPI:1780909515
Name:HEART, HEAD & HAND, INC.
Entity type:Organization
Organization Name:HEART, HEAD & HAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:386-986-8662
Mailing Address - Street 1:59 BAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8871
Mailing Address - Country:US
Mailing Address - Phone:386-986-8662
Mailing Address - Fax:386-447-7320
Practice Address - Street 1:59 BAYSIDE DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8871
Practice Address - Country:US
Practice Address - Phone:386-986-8662
Practice Address - Fax:386-447-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
FL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002127600Medicaid
FL811722500Medicaid
FL766088000Medicaid