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General NPI Number Information
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NPI Number | 1316414287
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Entity Type | Organization
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Legal Business Name | A HEAVENLY HOME, LLC
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 1046-1048 NW 8TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311-3331
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Country | US
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Telephone | 305-332-5034
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Fax |
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Provider Business Mailing Address
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Address Line | 21135 NW 14TH PL APT 157
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-2941
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Country | US
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Telephone | 305-332-5034
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CHARICE V DUCTANT
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Credential |
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Telephone | 305-332-5034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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