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General NPI Number Information
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NPI Number | 1629536305
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Entity Type | Organization
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Legal Business Name | HEAVENLY HOME LLC
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 2403 VILLAGE STONE CT
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City | KATY
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State | TX
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Zip | 77493-1476
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Country | US
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Telephone | 713-291-8626
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Fax |
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Provider Business Mailing Address
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Address Line | 2403 VILLAGE STONE CT
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City | KATY
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State | TX
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Zip | 77493-1476
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Country | US
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Telephone | 713-291-8626
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | CHRISTIANA OSE AMODU
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Credential |
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Telephone | 713-291-8626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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