MEDICARE: HEAVENLY ASSISTED LIVING, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1407467806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY ASSISTED LIVING, INC.

Provider Business Mailing Address
First Line	:	401 ORANGE AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4444
Country	:	US
Telephone Number	:	386-767-6268
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 ORANGE AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4444
Country	:	US
Telephone Number	:	386-761-6268
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YOHANNES FISSIHA
Credential	:
Telephone Number	:	386-767-6268

Provider Enumeration Date	:	08/11/2020
Last Update Date	:	08/24/2020

Similar Medicare Providers

1174798433 — ORANGE COUNTY NEWBORN MEDICARE CARE PC
Practice Location Address:

3 SAINT STEPHENS PL , SUITE 2
WARWICK, NY
10990-3208

Practice Phone: 845-987-9700
Practice Fax:

1295346690 — YOHANNES FISSIHA
Practice Location Address:

401 ORANGE AVE
PORT ORANGE, FL
32127-4444

Practice Phone: 386-767-6268
Practice Fax:

1841063963 — SARG PORT ORANGE ALF LLC
Practice Location Address:

401 ORANGE AVE
PORT ORANGE, FL
32127-4444

Practice Phone: 407-797-4996
Practice Fax:

1154710143 — MANDY LENTINI
Practice Location Address:

1583 N MORNINGSIDE ST
ORANGE, CA
92867-4444

Practice Phone: 714-865-7569
Practice Fax:

1982568341 — ROBIN KRUG
Practice Location Address:

1107 WARD ST
PORT HURON, MI
48060-4444

Practice Phone: 810-689-0491
Practice Fax:

1134951296 — ALISNE VALDES
Practice Location Address:

6803 TROPICAIRE BLVD
NORTH PORT, FL
34291-4444

Practice Phone: 941-441-5376
Practice Fax:

Directions to “HEAVENLY ASSISTED LIVING, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.