Provider Demographics
NPI:1457917312
Name:HEALING EDUCATIONAL ALTERNATIVES FOR DESERVING STUDENTS, LLC
Entity Type:Organization
Organization Name:HEALING EDUCATIONAL ALTERNATIVES FOR DESERVING STUDENTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-754-5555
Mailing Address - Street 1:1001 E BAKER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3700
Mailing Address - Country:US
Mailing Address - Phone:813-754-5555
Mailing Address - Fax:813-754-5552
Practice Address - Street 1:901 INDUSTRIAL DR STE 200
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-4707
Practice Address - Country:US
Practice Address - Phone:813-754-5555
Practice Address - Fax:813-754-5552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALING EDUCATIONAL ALTERNATIVES FOR DESERVING STUDENTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1326311085OtherNPI NUMBER FOR CORPORATE OFFICE