Provider Demographics
NPI:1881088847
Name:HEAVEN CYNT SERVICES LLC
Entity type:Organization
Organization Name:HEAVEN CYNT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRISTA
Authorized Official - Middle Name:L D
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-398-1516
Mailing Address - Street 1:PO BOX 1076
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39060-1076
Mailing Address - Country:US
Mailing Address - Phone:601-668-6994
Mailing Address - Fax:
Practice Address - Street 1:4632 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5433
Practice Address - Country:US
Practice Address - Phone:601-668-6994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health