Provider Demographics
NPI:1194365395
Name:HEAVEN5ENT LLC
Entity type:Organization
Organization Name:HEAVEN5ENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-300-7747
Mailing Address - Street 1:3241 TWINFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-5917
Mailing Address - Country:US
Mailing Address - Phone:757-300-7747
Mailing Address - Fax:757-689-6180
Practice Address - Street 1:3241 TWINFLOWER LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-5917
Practice Address - Country:US
Practice Address - Phone:757-300-7747
Practice Address - Fax:757-689-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)