MEDICARE: HEAVEN ACADEMY CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1578009338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVEN ACADEMY CORP

Provider Business Mailing Address
First Line	:	2807 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4411
Country	:	US
Telephone Number	:	407-601-3553
Fax Number	:	407-613-5600

Provider Business Practice Location Address
First Line	:	2807 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4411
Country	:	US
Telephone Number	:	407-601-3553
Fax Number	:	407-613-5600

Authorized Official
Title or Position	:	DIRECTOR
Name	:	FRANCISCO NAVARRO MARTIN
Credential	:
Telephone Number	:	786-775-8804

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	01/17/2017

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