Provider Demographics
NPI:1144549551
Name:MENDING HEARTS INC
Entity type:Organization
Organization Name:MENDING HEARTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-668-2260
Mailing Address - Street 1:1002 44TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-1529
Mailing Address - Country:US
Mailing Address - Phone:615-385-1696
Mailing Address - Fax:615-385-5016
Practice Address - Street 1:4305 ALBION ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-2300
Practice Address - Country:US
Practice Address - Phone:615-385-1696
Practice Address - Fax:615-385-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 2084P0802X, 261QR0405X, 343800000X
TN1000000005952324500000X, 343800000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No343800000XTransportation ServicesSecured Medical Transport (VAN)