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General NPI Number Information
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NPI Number | 1437246345
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Entity Type | Organization
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Legal Business Name | HEAVENLY ARMS LLC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 2470 EMERALD PL SUITE D
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City | GREENVILLE
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State | NC
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Zip | 27834-5786
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Country | US
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Telephone | 252-752-3211
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Fax | 252-752-3211
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Provider Business Mailing Address
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Address Line | 2470 EMERALD PL SUITE D
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City | GREENVILLE
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State | NC
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Zip | 27834-5786
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Country | US
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Telephone | 252-752-3211
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Fax | 252-752-3211
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Authorized Official
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Title or Position | CEO
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Name | DANIEL GABRIEL MOORE
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Credential |
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Telephone | 252-752-3211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL-074-164
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 88301613B
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License Number State | NC
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