| Heart-active Llc | |
|
1323 Broadway St Little Rock AR 72202-4843 | |
| (501) 580-3335 | |
| Not Available |
| Full Name | Heart-active Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1323 Broadway St, Little Rock, Arkansas |
| Authorized Official Name and Position | Ruth L Eudy (INCORPORATOR/ORGANIZER) |
| Authorized Official Contact | 5015803335 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heart-active Llc 1323 Broadway St Little Rock AR 72202-4843 Ph: () - | Heart-active Llc 1323 Broadway St Little Rock AR 72202-4843 Ph: (501) 580-3335 |
| NPI Number | 1801547146 |
|---|---|
| Provider Enumeration Date | 01/18/2022 |
| Last Update Date | 01/18/2022 |
| Certification Date | 01/18/2022 |
| Medicare PECOS PAC ID | 4789036260 |
|---|---|
| Medicare Enrollment ID | O20240119003515 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801547146 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Ruth L Eudy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174284624 PECOS PAC ID: 6406210772 Enrollment ID: I20240206001503 |
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