Provider Demographics
NPI:1508102419
Name:A & K HEAVENLY HOMES INC
Entity Type:Organization
Organization Name:A & K HEAVENLY HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHILAN
Authorized Official - Middle Name:ELISA
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-565-5556
Mailing Address - Street 1:3304 SANDLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1378
Mailing Address - Country:US
Mailing Address - Phone:256-308-9756
Mailing Address - Fax:256-552-1838
Practice Address - Street 1:3304 SANDLIN RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1378
Practice Address - Country:US
Practice Address - Phone:256-308-9756
Practice Address - Fax:256-552-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health