Healthcare Provider Details

I. General information

NPI: 1689320996
Provider Name (Legal Business Name): HEAVENLY HOME SWEET HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 JORK RD STE 101
JACKSONVILLE FL
32207-2492
US

IV. Provider business mailing address

15770 STEDMAN LAKE DR
JACKSONVILLE FL
32218-0619
US

V. Phone/Fax

Practice location:
  • Phone: 904-453-8129
  • Fax: 888-402-9512
Mailing address:
  • Phone: 904-453-8129
  • Fax: 888-402-9512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. GAIL JAMES
Title or Position: CEO
Credential: PHD.
Phone: 904-554-2185