Organization
HEAVENLY HOMECARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMEKA LASEAN WILLIAMS (OWNER)
(678) 362-4708
Entity
Organization
Contact information
Practice address
4980 VILLAGER LN, STONE MOUNTAIN, GA 30083-3698
(678) 362-4708
Mailing address
4980 VILLAGER LN, STONE MOUNTAIN, GA 30083-3698
(678) 362-4708
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
02/03/2014
Last updated
02/03/2014
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