Provider Demographics
NPI:1114354602
Name:HEAVENS DOOR HCS
Entity Type:Organization
Organization Name:HEAVENS DOOR HCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:IBONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-641-1529
Mailing Address - Street 1:8313 SILVERADO TRL
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2674
Mailing Address - Country:US
Mailing Address - Phone:214-641-1529
Mailing Address - Fax:972-369-7789
Practice Address - Street 1:8313 SILVERADO TRL
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2674
Practice Address - Country:US
Practice Address - Phone:214-641-1529
Practice Address - Fax:972-369-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health