Provider Demographics
NPI:1881838944
Name:HEAGS, THOMEKA T (CNA, PCT)
Entity Type:Individual
Prefix:MISS
First Name:THOMEKA
Middle Name:T
Last Name:HEAGS
Suffix:
Gender:F
Credentials:CNA, PCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21816 LAKESHIRE ST # 806081
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2862
Mailing Address - Country:US
Mailing Address - Phone:586-601-8097
Mailing Address - Fax:
Practice Address - Street 1:21816 LAKESHIRE ST # 806081
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2862
Practice Address - Country:US
Practice Address - Phone:586-601-8097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X, 172A00000X, 372500000X, 3747A0650X, 3747P1801X
MI230251200698164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriver
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1881838944OtherALL MEDICAL
MI1881838944Medicaid