Provider Demographics
NPI:1902416191
Name:HEAVENLY LIVING LLC
Entity Type:Organization
Organization Name:HEAVENLY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANGA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:804-481-0313
Mailing Address - Street 1:21101 DEODORA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23803-2224
Mailing Address - Country:US
Mailing Address - Phone:804-481-0313
Mailing Address - Fax:
Practice Address - Street 1:21101 DEODORA DR
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23803-2224
Practice Address - Country:US
Practice Address - Phone:804-481-0313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities