Provider Demographics
NPI:1477892180
Name:HDK LLC
Entity Type:Organization
Organization Name:HDK LLC
Other - Org Name:HEAVENLY HEALING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:MR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-237-4836
Mailing Address - Street 1:118 PEBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-9524
Mailing Address - Country:US
Mailing Address - Phone:304-237-4836
Mailing Address - Fax:
Practice Address - Street 1:118 PEBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-9524
Practice Address - Country:US
Practice Address - Phone:304-237-4836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty