Healthcare Provider Details

I. General information

NPI: 1184851453
Provider Name (Legal Business Name): HEAVEN-ON-EARTH NETWORK OF MAMOU, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 4TH STREET
MAMOU LA
70554
US

IV. Provider business mailing address

1321 4TH STREET
MAMOU LA
70554
US

V. Phone/Fax

Practice location:
  • Phone: 337-468-2730
  • Fax: 337-468-2782
Mailing address:
  • Phone: 337-468-2730
  • Fax: 337-468-2782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number20161
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number15227
License Number StateLA

VIII. Authorized Official

Name: MR. MYRON CORDELL GUILLORY
Title or Position: OWNER
Credential:
Phone: 434-229-4962