Provider Demographics
NPI:1093481210
Name:HEALING EDUCATIONAL ALTERNATIVES FOR DESERVING STUDENTS, LLC. (HEADS)
Entity Type:Organization
Organization Name:HEALING EDUCATIONAL ALTERNATIVES FOR DESERVING STUDENTS, LLC. (HEADS)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-754-5555
Mailing Address - Street 1:1001 EAST BAKER STREET, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3700
Mailing Address - Country:US
Mailing Address - Phone:813-754-5555
Mailing Address - Fax:
Practice Address - Street 1:5749 WESTGATE DR STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5040
Practice Address - Country:US
Practice Address - Phone:813-754-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency