Organization
HEAVENLY ASSISTED CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HEAVENLY E. KIMES D.D.S (PRESIDENT)
(678) 625-7505
Entity
Organization
Contact information
Practice address
10555 ASPENWOOD CT, JONESBORO, GA 30238
(404) 713-4982
(678) 413-2491
Mailing address
3240 GLENCREE RD, CONYERS, GA 30012-8836
(404) 713-4982
(678) 413-2491
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
DN012304
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
481264351A
—
GA
Enumeration date
01/05/2010
Last updated
01/07/2010
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