Provider Demographics
NPI:1316755143
Name:OPEN HEARTS
Entity type:Organization
Organization Name:OPEN HEARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-285-5550
Mailing Address - Street 1:4414 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-4114
Mailing Address - Country:US
Mailing Address - Phone:602-285-5550
Mailing Address - Fax:
Practice Address - Street 1:21853 S 214TH ST
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5964
Practice Address - Country:US
Practice Address - Phone:602-285-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility