Provider Demographics
NPI:1689320996
Name:HEAVENLY HOME SWEET HOME, INC.
Entity Type:Organization
Organization Name:HEAVENLY HOME SWEET HOME, INC.
Other - Org Name:XTRAORDINARY SERVICES 4 XTRAORDINARY PEOPLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-554-2185
Mailing Address - Street 1:15770 STEDMAN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-0619
Mailing Address - Country:US
Mailing Address - Phone:904-862-7700
Mailing Address - Fax:888-402-9512
Practice Address - Street 1:3733 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2109
Practice Address - Country:US
Practice Address - Phone:904-453-8129
Practice Address - Fax:888-402-9512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI00802OtherZIPCODE