National Provider Identifier Database

HEARTHSTONE DERMATOLOGY NONPROFIT PROFESSIONAL SERVICES
Voluntary or Charitable


Contact Information

HEARTHSTONE DERMATOLOGY NONPROFIT PROFESSIONAL SERVICES
828 MOX CHEHALIS RD
MCCLEARY, WA98557-9408
Phone: 360-470-0671
Fax: 360-464-2617
Website:
Specialty Taxonomy Code
* Voluntary or Charitable 251V00000X

* Indicates primary specialty

NPI Profile & details for HEARTHSTONE DERMATOLOGY NONPROFIT PROFESSIONAL SERVICES

NPI Number 1477169753
Legal business name
LBN
HEARTHSTONE DERMATOLOGY NONPROFIT PROFESSIONAL SERVICES
Authorized official GENEVA TZENOV - (CEO-ADMINISTRATOR)
Entity Organization
Organization subpart No
Enumeration date 09/22/2020
Last updated 09/22/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • WA Medicaid: 2012498

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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