Provider Demographics
NPI:1831391853
Name:MENDING HEARTS
Entity type:Organization
Organization Name:MENDING HEARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-633-1126
Mailing Address - Street 1:95 FIELDS CLF
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-7338
Mailing Address - Country:US
Mailing Address - Phone:606-633-1126
Mailing Address - Fax:606-633-1126
Practice Address - Street 1:95 FIELDS CLF
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7338
Practice Address - Country:US
Practice Address - Phone:606-633-1126
Practice Address - Fax:606-633-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage