Provider Demographics
NPI:1952156739
Name:HEART ON ICE
Entity Type:Organization
Organization Name:HEART ON ICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOO
Authorized Official - Prefix:MR
Authorized Official - First Name:FEISAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMBY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:419-360-7994
Mailing Address - Street 1:4736 N TEAL LN
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-1674
Mailing Address - Country:US
Mailing Address - Phone:419-360-7994
Mailing Address - Fax:
Practice Address - Street 1:4736 N TEAL LN
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-1674
Practice Address - Country:US
Practice Address - Phone:419-360-7994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle