# HEAVENLY ASSISTED CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518297175
- **Authorized official:** DR. HEAVENLY E. KIMES D.D.S (PRESIDENT)
- **Authorized official phone:** (678) 625-7505

## Contact information

- **Practice address:** 10555 ASPENWOOD CT, JONESBORO, GA 30238
- **Practice address phone:** (404) 713-4982
- **Practice address fax:** (678) 413-2491
- **Mailing address:** 3240 GLENCREE RD, CONYERS, GA 30012-8836
- **Mailing address phone:** (404) 713-4982
- **Mailing address fax:** (678) 413-2491

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | DN012304 | GA | Yes |

## Other

- **Enumeration date:** 01/05/2010
- **Last updated:** 01/07/2010