Provider Demographics
NPI:1366794547
Name:HEARTHSTONE COMMUNITY SERVICES
Entity type:Organization
Organization Name:HEARTHSTONE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DAMATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-331-2075
Mailing Address - Street 1:721 BRUNDAGE LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-3101
Mailing Address - Country:US
Mailing Address - Phone:661-861-0051
Mailing Address - Fax:661-861-0053
Practice Address - Street 1:721 BRUNDAGE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-3101
Practice Address - Country:US
Practice Address - Phone:661-861-0051
Practice Address - Fax:661-861-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01813OtherLEGAL ENTITY NUMBER