Provider Demographics
NPI:1306470653
Name:ONE HEART RESIDENTIAL
Entity type:Organization
Organization Name:ONE HEART RESIDENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAPPIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:804-326-1377
Mailing Address - Street 1:129 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:23075-1413
Mailing Address - Country:US
Mailing Address - Phone:804-326-1377
Mailing Address - Fax:804-326-6215
Practice Address - Street 1:129 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:23075-1413
Practice Address - Country:US
Practice Address - Phone:804-326-1377
Practice Address - Fax:804-326-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty