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Organization
HEAVENLY HAVEN
Active
Organization
HEAVENLY HAVEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA DYER (CEO/OWNER)
(832) 433-8433
Entity
Organization
Contact information
Practice address
4748 CLOVER ST, UNIT A, HOUSTON, TX 77033-4047
(832) 433-8433
Mailing address
4748 CLOVER ST, UNIT A, HOUSTON, TX 77033-4047
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649628033
—
TX
Enumeration date
10/24/2016
Last updated
02/22/2019
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