Provider Demographics
NPI:1912606757
Name:GUIDED HEART LLC
Entity Type:Organization
Organization Name:GUIDED HEART LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-926-1188
Mailing Address - Street 1:1856 RAMBLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2938
Mailing Address - Country:US
Mailing Address - Phone:804-926-1188
Mailing Address - Fax:
Practice Address - Street 1:1856 RAMBLEWOOD RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2938
Practice Address - Country:US
Practice Address - Phone:804-926-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health