Provider Demographics
NPI:1285174292
Name:HEATON HEALTH SERVICES AGENCY LLC
Entity type:Organization
Organization Name:HEATON HEALTH SERVICES AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-239-1430
Mailing Address - Street 1:1820 SHILOH RD STE 1503
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-2459
Mailing Address - Country:US
Mailing Address - Phone:903-630-5493
Mailing Address - Fax:903-965-6384
Practice Address - Street 1:1820 SHILOH RD STE 1503
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2459
Practice Address - Country:US
Practice Address - Phone:903-630-5493
Practice Address - Fax:903-965-6384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health