Provider Demographics
NPI:1356060636
Name:MAIDS OF HEAVEN
Entity type:Organization
Organization Name:MAIDS OF HEAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNIECE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON-GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-244-7264
Mailing Address - Street 1:2379 SAWBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-6520
Mailing Address - Country:US
Mailing Address - Phone:330-244-7264
Mailing Address - Fax:
Practice Address - Street 1:2379 SAWBURY BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-6520
Practice Address - Country:US
Practice Address - Phone:330-244-7264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)