Provider Demographics
NPI:1528896503
Name:PURE HEART THERAPEUTIC SERVICES, LLC
Entity type:Organization
Organization Name:PURE HEART THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:614-321-9064
Mailing Address - Street 1:6249 UPPERRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WNCHSTR
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9196
Mailing Address - Country:US
Mailing Address - Phone:614-321-9064
Mailing Address - Fax:
Practice Address - Street 1:6249 UPPERRIDGE DR
Practice Address - Street 2:
Practice Address - City:CANAL WNCHSTR
Practice Address - State:OH
Practice Address - Zip Code:43110-9196
Practice Address - Country:US
Practice Address - Phone:614-321-9064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)