Provider Demographics
NPI:1982350377
Name:HEAVENLY HOME SWEET HOME, INC.
Entity type:Organization
Organization Name:HEAVENLY HOME SWEET HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:340-473-2368
Mailing Address - Street 1:15770 STEDMAN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-0619
Mailing Address - Country:US
Mailing Address - Phone:904-554-2185
Mailing Address - Fax:888-402-9512
Practice Address - Street 1:14B-3 ESTATE THOMAS
Practice Address - Street 2:
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-473-2368
Practice Address - Fax:888-402-9512
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEAVENLY HOME SWEET HOME, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1990OtherCOUNSELING AND CONSULTING SERVICES