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General NPI Number Information
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NPI Number | 1508102419
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Entity Type | Organization
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Legal Business Name | A & K HEAVENLY HOMES INC
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Dates
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Enumeration Date | 12/20/2012
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 3304 SANDLIN RD SW
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City | DECATUR
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State | AL
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Zip | 35603-1378
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Country | US
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Telephone | 256-308-9756
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Fax | 256-552-1838
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Provider Business Mailing Address
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Address Line | 3304 SANDLIN RD SW
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City | DECATUR
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State | AL
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Zip | 35603-1378
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Country | US
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Telephone | 256-308-9756
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Fax | 256-552-1838
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHILAN ELISA FITCH
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Credential |
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Telephone | 256-565-5556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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