Provider Demographics
NPI:1871838466
Name:THE HEAVENLY OAK ADULT DAY CARE
Entity Type:Organization
Organization Name:THE HEAVENLY OAK ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:RICE
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-548-6555
Mailing Address - Street 1:2695 STANTON KOKO RD
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:TN
Mailing Address - Zip Code:38069-3417
Mailing Address - Country:US
Mailing Address - Phone:731-548-6704
Mailing Address - Fax:
Practice Address - Street 1:8 OAK STREET
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:TN
Practice Address - Zip Code:38069-3417
Practice Address - Country:US
Practice Address - Phone:731-548-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home