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General NPI Number Information
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NPI Number | 1073370359
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Entity Type | Organization
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Legal Business Name | HEAVEN BOUND LLC
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 3166 STAR DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-7186
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Country | US
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Telephone | 928-732-6722
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 344
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City | HELENDALE
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State | CA
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Zip | 92342-0344
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Country | US
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Telephone | 805-868-1269
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. FERNANDO LUIS REMEDIOS
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Credential |
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Telephone | 805-868-1269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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