Provider Demographics
NPI:1699013714
Name:HEAVENLY ARMS ASSISTED LIVING PERSONAL CARE HOME
Entity Type:Organization
Organization Name:HEAVENLY ARMS ASSISTED LIVING PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-625-4216
Mailing Address - Street 1:11230 HIGHWAY 278 E
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-1673
Mailing Address - Country:US
Mailing Address - Phone:678-625-4216
Mailing Address - Fax:678-625-7793
Practice Address - Street 1:11230 HIGHWAY 278 E
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1673
Practice Address - Country:US
Practice Address - Phone:678-625-4216
Practice Address - Fax:678-625-7793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABLP-18639251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care