Organization
HEAVENLY ASSISTED LIVING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YOHANNES FISSIHA (OWNER)
(386) 767-6268
Entity
Organization
Contact information
Practice address
401 ORANGE AVE, PORT ORANGE, FL 32127-4444
(386) 761-6268
Mailing address
401 ORANGE AVE, PORT ORANGE, FL 32127-4444
(386) 767-6268
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
08/11/2020
Last updated
08/24/2020
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