Provider Demographics
NPI:1932893369
Name:THE DEHEAVENLY HOME, LLC
Entity Type:Organization
Organization Name:THE DEHEAVENLY HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZAKIYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PANNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:434-251-3466
Mailing Address - Street 1:15 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ALTAVISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24517-1013
Mailing Address - Country:US
Mailing Address - Phone:434-251-3466
Mailing Address - Fax:
Practice Address - Street 1:1006 8TH ST
Practice Address - Street 2:
Practice Address - City:ALTAVISTA
Practice Address - State:VA
Practice Address - Zip Code:24517-1506
Practice Address - Country:US
Practice Address - Phone:434-251-3466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services