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General NPI Number Information
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NPI Number | 1831440155
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Entity Type | Organization
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Legal Business Name | HEAVENLY CHOICE ADULT HOME
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 5500 WATKINS RD
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City | HAINES CITY
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State | FL
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Zip | 33844-6254
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Country | US
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Telephone | 863-269-9753
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 WATKINS RD
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City | HAINES CITY
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State | FL
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Zip | 33844-6254
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Country | US
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Telephone | 863-269-9753
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. JULIA MORAME
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Credential |
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Telephone | 863-269-9753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 6906270
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License Number State | FL
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