Organization
HEAVENLY ARMS LLC
Active
Organization
HEAVENLY ARMS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL GABRIEL MOORE (CEO)
(252) 752-3211
Entity
Organization
Contact information
Practice address
2470 EMERALD PL, SUITE D, GREENVILLE, NC 27834-5786
(252) 752-3211
(252) 752-3211
Mailing address
2470 EMERALD PL, SUITE D, GREENVILLE, NC 27834-5786
(252) 752-3211
(252) 752-3211
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-074-164
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
88301613B
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301613G
—
NC
05
—
8601613B
—
NC
01
—
MHL-074-164
DFS LICENSE NUMBER
NC
Enumeration date
10/10/2006
Last updated
05/05/2008
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