Provider Demographics
NPI:1073370359
Name:HEAVEN BOUND LLC
Entity Type:Organization
Organization Name:HEAVEN BOUND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:REMEDIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-868-1269
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:HELENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:92342-0344
Mailing Address - Country:US
Mailing Address - Phone:805-868-1269
Mailing Address - Fax:
Practice Address - Street 1:3166 STAR DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-7186
Practice Address - Country:US
Practice Address - Phone:928-732-6722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility