Provider Demographics
NPI:1720827512
Name:HEART CENTERED HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:HEART CENTERED HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S, LICDC-CS
Authorized Official - Phone:330-840-9385
Mailing Address - Street 1:217 W HOMESTEAD ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3129
Mailing Address - Country:US
Mailing Address - Phone:330-840-9385
Mailing Address - Fax:330-595-4392
Practice Address - Street 1:217 W HOMESTEAD ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3129
Practice Address - Country:US
Practice Address - Phone:330-840-9385
Practice Address - Fax:330-595-4392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)