Provider Demographics
NPI:1629536305
Name:HEAVENLY HOME LLC
Entity Type:Organization
Organization Name:HEAVENLY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:OSE
Authorized Official - Last Name:AMODU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-291-8626
Mailing Address - Street 1:2403 VILLAGE STONE CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-1476
Mailing Address - Country:US
Mailing Address - Phone:713-291-8626
Mailing Address - Fax:
Practice Address - Street 1:2403 VILLAGE STONE CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-1476
Practice Address - Country:US
Practice Address - Phone:713-291-8626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities