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General NPI Number Information
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NPI Number | 1891519872
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Entity Type | Organization
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Legal Business Name | HEAVENLY ANGELS COMMUNITY LIVING, INC.
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 704 W MAIN ST
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City | OKOLONA
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State | MS
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Zip | 38860-1627
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Country | US
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Telephone | 662-295-6514
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Fax |
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Provider Business Mailing Address
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Address Line | 704 W MAIN ST
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City | OKOLONA
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State | MS
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Zip | 38860-1627
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Country | US
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Telephone | 662-295-6514
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JEROME WALKER
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Credential |
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Telephone | 662-295-6514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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