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General NPI Number Information
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NPI Number | 1457617276
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Entity Type | Organization
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Legal Business Name | HEAVENLY SPIRITS
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 1007 PARADISE VIEW ST
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City | HENDERSON
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State | NV
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Zip | 89052-3937
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Country | US
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Telephone | 310-503-5362
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Fax |
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Provider Business Mailing Address
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Address Line | 4626 ARLINGTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90043-1451
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Country | US
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Telephone | 323-292-4193
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Fax | 323-292-8647
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Authorized Official
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Title or Position | DIRECTOR
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Name | MONICA RAE WILLIAMS
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Credential |
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Telephone | 323-292-4193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 65267405
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License Number State | CA
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