Organization
HEAVENLY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KANOBAYITA DORIS (CEO)
(601) 316-1347
Entity
Organization
Contact information
Practice address
3129 W ACAPULCO LN, PHOENIX, AZ 85053-4885
(601) 316-1347
Mailing address
3129 W ACAPULCO LN, PHOENIX, AZ 85053-4885
(601) 316-1347
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
092973
—
AZ
Enumeration date
05/24/2021
Last updated
02/28/2023
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