Provider Demographics
NPI:1760612071
Name:HEAVENLY SENT
Entity Type:Organization
Organization Name:HEAVENLY SENT
Other - Org Name:HEAVENLY SENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-600-3787
Mailing Address - Street 1:6110 HILLANDALE DR.
Mailing Address - Street 2:
Mailing Address - City:COLLEGEPARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-4250
Mailing Address - Country:US
Mailing Address - Phone:678-600-3787
Mailing Address - Fax:
Practice Address - Street 1:6110 HILLANDALE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-4250
Practice Address - Country:US
Practice Address - Phone:678-600-3787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000016220251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health