Provider Demographics
NPI:1679822431
Name:HEAVENLY COMFORT AFC LLC
Entity Type:Organization
Organization Name:HEAVENLY COMFORT AFC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEANA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WALDBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-434-5810
Mailing Address - Street 1:19103 WOODMONT ST
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1319
Mailing Address - Country:US
Mailing Address - Phone:313-434-5810
Mailing Address - Fax:
Practice Address - Street 1:19103 WOODMONT ST
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1319
Practice Address - Country:US
Practice Address - Phone:313-434-5810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820316694310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness