Provider Demographics
NPI:1457617276
Name:HEAVENLY SPIRITS
Entity Type:Organization
Organization Name:HEAVENLY SPIRITS
Other - Org Name:H.S. INC. LIFE SKILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-292-4193
Mailing Address - Street 1:4626 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1451
Mailing Address - Country:US
Mailing Address - Phone:323-292-4193
Mailing Address - Fax:323-292-8647
Practice Address - Street 1:1007 PARADISE VIEW ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3937
Practice Address - Country:US
Practice Address - Phone:310-503-5362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65267405251C00000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services