Provider Demographics
NPI:1043562812
Name:HEALING HEARTS HOLISTICALLY INC.
Entity type:Organization
Organization Name:HEALING HEARTS HOLISTICALLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LUCILLE
Authorized Official - Last Name:JEZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, ACNS-BC
Authorized Official - Phone:508-584-3278
Mailing Address - Street 1:348 NORTH PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2135
Mailing Address - Country:US
Mailing Address - Phone:508-584-3278
Mailing Address - Fax:508-584-3279
Practice Address - Street 1:348 NORTH PEARL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2135
Practice Address - Country:US
Practice Address - Phone:508-584-3278
Practice Address - Fax:508-584-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN173824261QC1500X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health