Provider Demographics
NPI:1215003397
Name:HEAVEN-ON-EARTH NETWORK, INC.
Entity Type:Organization
Organization Name:HEAVEN-ON-EARTH NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUILLORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-562-1373
Mailing Address - Street 1:3200 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8922
Mailing Address - Country:US
Mailing Address - Phone:337-562-1373
Mailing Address - Fax:337-562-1374
Practice Address - Street 1:3200 2ND AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8922
Practice Address - Country:US
Practice Address - Phone:337-562-1373
Practice Address - Fax:337-562-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 10734251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1171336Medicaid