Provider Demographics
NPI:1114703667
Name:HEAVEN COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:HEAVEN COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEREMIAS
Authorized Official - Middle Name:MBUMBA
Authorized Official - Last Name:BUIDI
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:207-520-3741
Mailing Address - Street 1:196 PARK ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7325
Mailing Address - Country:US
Mailing Address - Phone:207-520-3741
Mailing Address - Fax:
Practice Address - Street 1:196 PARK ST APT 2R
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7325
Practice Address - Country:US
Practice Address - Phone:207-520-3741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities