HEAVENLY PLACE LLC II NPI 1356683445

NPI Information

HEAVENLY PLACE LLC II is a residential treatment facility, intellectual and/or developmental disabilities in Raleigh, NC. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. HEAVENLY PLACE LLC II NPI is 1356683445. The provider is registered as an organization entity type.

The provider's business location address is:

2105 GRESHAM LAKE RD
RALEIGH, NC
ZIP 27615-204
Phone: (919) 819-3882

The provider's authorized official is Juliet Okwoshah .
The authorized official title is Administration and has the following contact phone number (919) 819-3882.

The CLIA number assigned to this NPI record is 34D2206321 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/27/2013 and was last updated on 3/27/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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