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General NPI Number Information
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NPI Number | 1760612071
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Entity Type | Organization
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Legal Business Name | HEAVENLY SENT
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 07/21/2009
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Provider Practice Location Address
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Address Line | 6110 HILLANDALE DR
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City | COLLEGE PARK
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State | GA
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Zip | 30349-4250
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Country | US
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Telephone | 678-600-3787
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Fax |
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Provider Business Mailing Address
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Address Line | 6110 HILLANDALE DR.
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City | COLLEGEPARK
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State | GA
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Zip | 30349-4250
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Country | US
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Telephone | 678-600-3787
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | RENAE WALKER
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Credential |
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Telephone | 678-600-3787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | CN0000016220
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License Number State | GA
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