Provider Demographics
NPI:1962846600
Name:HIGHWAY TO HEAVEN LLC
Entity Type:Organization
Organization Name:HIGHWAY TO HEAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-873-4674
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:DOERUN
Mailing Address - State:GA
Mailing Address - Zip Code:31744
Mailing Address - Country:US
Mailing Address - Phone:229-873-4674
Mailing Address - Fax:
Practice Address - Street 1:152 EDGE ROAD
Practice Address - Street 2:
Practice Address - City:DOERUN
Practice Address - State:GA
Practice Address - Zip Code:31744
Practice Address - Country:US
Practice Address - Phone:229-873-4674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility