Organization
HEAVENLY MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLAUDIA DENICE HARRIS (MEDICAL SUPPLIER)
(318) 283-1210
Entity
Organization
Contact information
Practice address
6349 ESTATES DR, BASTROP, LA 71220-9749
(318) 283-1210
Mailing address
6349 ESTATES DR, BASTROP, LA 71220-9749
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/13/2009
Last updated
01/13/2009
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