Organization Name: | INTENTIONAL HEARTS, INC. |
NPI Number: | 1003056698 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL TODD WILSON (PRESIDENT) |
Mailing Address: | 4200 Northside Pkwy Nw Bldg 1, Ste 200 Atlanta |
State: | GA US |
Postal Code: | 303273054 |
Phone Number: | 7706233331 |
Fax Number: | |
NPI Enumeration Date: | 02/23/2009 |
NPI Last Update Date: | 02/23/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | LPC004107 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |