MEDICARE: HEAVENS WAY SERVICES 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1558921817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENS WAY SERVICES INC

Provider Business Mailing Address
First Line	:	9710 FIVE OAKS RD
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-1109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9710 FIVE OAKS RD
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-1109
Country	:	US
Telephone Number	:	301-793-9840
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARTINE TCHUEMBUE
Credential	:
Telephone Number	:	301-793-9840

Provider Enumeration Date	:	06/19/2019
Last Update Date	:	06/19/2019

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