Hearthstone Dermatology Nonprofit Professional Services

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

HEARTHSTONE DERMATOLOGY NONPROFIT PROFESSIONAL SERVICES

Practice address

828 Mox Chehalis Rd
McCleary, WA 98557-9408

Phone

(360) 470-0671

Fax

(360) 464-2617

NPI assigned

Sep 22, 2020

Last updated

Sep 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Geneva Tzenov, FNP-CNPI 1881831501

Title

Ceo-Administrator

Phone

(360) 470-0671

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Geneva S Tzenov, FNP-C

  • Family Nurse Practitioner
  • McCleary, WA
  • NPI 1881831501
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600732800000",
    "number": "1477169753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 MOX CHEHALIS RD",
            "city": "MCCLEARY",
            "state": "WA",
            "postal_code": "985579408",
            "telephone_number": "360-470-0671",
            "fax_number": "360-464-2617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 MOX CHEHALIS RD",
            "city": "MCCLEARY",
            "state": "WA",
            "postal_code": "985579408",
            "telephone_number": "360-470-0671",
            "fax_number": "360-464-2617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTHSTONE DERMATOLOGY NONPROFIT PROFESSIONAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-22",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A",
        "authorized_official_last_name": "TZENOV",
        "authorized_official_first_name": "GENEVA",
        "authorized_official_title_or_position": "CEO-ADMINISTRATOR",
        "authorized_official_telephone_number": "360-470-0671",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2012498",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Hearthstonederm.org",
            "affiliation": "N",
            "address_1": "828 Mox Chehalis Rd",
            "city": "McCleary",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985579408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Karen Grosso, RN
• Rachal Gustafson
• Diana Haddox
• Angelique Haskell
• Christina Hazen
• Stephanie Helen Higgins, AAC
• Jenny Holmes, COUNSELOR
• Mary Hornback
• Nicole Howard
• Mary Elizabeth Hranac, LMP

• Voluntary or Charitable Agency in McCleary, WA
• Providers in McCleary, WA by specialty
• Voluntary or Charitable Agency in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.