Provider Demographics
NPI:1194592196
Name:HEALING HEARTS RESIDENCE
Entity type:Organization
Organization Name:HEALING HEARTS RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LOVE
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:651-955-8312
Mailing Address - Street 1:3120 BATTEN CIR APT 8304
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8130
Mailing Address - Country:US
Mailing Address - Phone:817-909-3694
Mailing Address - Fax:
Practice Address - Street 1:3120 BATTEN CIR APT 8304
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8130
Practice Address - Country:US
Practice Address - Phone:817-909-3694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health