Provider Demographics
NPI:1609211226
Name:HEAVEN ON EARTH
Entity Type:Organization
Organization Name:HEAVEN ON EARTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAYETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-717-5421
Mailing Address - Street 1:759 E 10TH ST
Mailing Address - Street 2:SUITE 3-D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2347
Mailing Address - Country:US
Mailing Address - Phone:718-717-5421
Mailing Address - Fax:
Practice Address - Street 1:759 E 10TH ST
Practice Address - Street 2:SUITE 3-D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2347
Practice Address - Country:US
Practice Address - Phone:718-717-5421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care