Provider Demographics
NPI:1730731910
Name:PUZZLED HEARTS LLC
Entity type:Organization
Organization Name:PUZZLED HEARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-859-0332
Mailing Address - Street 1:10001 VILLAGE GREEN DR STE B
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1148
Mailing Address - Country:US
Mailing Address - Phone:443-859-0332
Mailing Address - Fax:
Practice Address - Street 1:10001 VILLAGE GREEN DR STE B
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:MD
Practice Address - Zip Code:21163-1148
Practice Address - Country:US
Practice Address - Phone:443-859-0332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health