Provider Demographics
NPI:1154985877
Name:HEART 2 HEART GROUP HOMES INC
Entity type:Organization
Organization Name:HEART 2 HEART GROUP HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINTZELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-617-2087
Mailing Address - Street 1:411 THOMAS CIR NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-4976
Mailing Address - Country:US
Mailing Address - Phone:330-617-2087
Mailing Address - Fax:
Practice Address - Street 1:1007 RIDGE RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-2105
Practice Address - Country:US
Practice Address - Phone:330-617-2087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0334254Medicaid