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General NPI Number Information
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NPI Number | 1750748166
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Entity Type | Organization
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Legal Business Name | HEAVENLY FOODS
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Dates
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Enumeration Date | 01/15/2016
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Last Update Date | 01/15/2016
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Provider Practice Location Address
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Address Line | 4040 SW 69TH AVE
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City | MIRAMAR
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State | FL
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Zip | 33023-6688
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Country | US
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Telephone | 786-426-2611
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Fax | 954-404-7601
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Provider Business Mailing Address
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Address Line | 4040 SW 69TH AVE
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City | MIRAMAR
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State | FL
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Zip | 33023-6688
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Country | US
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Telephone | 786-426-2611
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Fax | 954-404-7601
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Authorized Official
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Title or Position | OWNER
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Name | PASHUN DOBSON
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Credential |
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Telephone | 786-426-2611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number | SEA1617838
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number | SEA1617838
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License Number State | FL
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