1982350377 NPI number — HEAVENLY HOME SWEET HOME, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982350377 NPI number — HEAVENLY HOME SWEET HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEAVENLY HOME SWEET HOME, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982350377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15770 STEDMAN LAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32218-0619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-554-2185
Provider Business Mailing Address Fax Number:
888-402-9512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14B-3 ESTATE THOMAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. THOMAS
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-473-2368
Provider Business Practice Location Address Fax Number:
888-402-9512
Provider Enumeration Date:
02/24/2022

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
340-473-2368

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1990 . This is a "COUNSELING AND CONSULTING SERVICES" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".




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