Provider Demographics
NPI:1376850545
Name:HEAVENLY DEVINE BLESSING
Entity Type:Organization
Organization Name:HEAVENLY DEVINE BLESSING
Other - Org Name:BIG MAMA'S KITCHEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:EGGLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-882-3643
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-7442
Mailing Address - Country:US
Mailing Address - Phone:912-882-3643
Mailing Address - Fax:
Practice Address - Street 1:105 NORTH LEE STREET
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548
Practice Address - Country:US
Practice Address - Phone:912-729-6563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2445332U00000X
GA1-9483332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals