Heavenlygates, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

MHL-041-882 Issued in NC

Legal business name

HEAVENLYGATES, INC.

Practice address

1407 Dunbar St
Greensboro, NC 27401-3801

Phone

(336) 617-3036

Fax

(336) 617-3036

NPI assigned

Dec 11, 2008

Last updated

Dec 11, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tarsha Violet Howard, L.P.N.

Title

Director

Phone

(336) 254-3137

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228953600000",
    "number": "1013152578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 DUNBAR ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274013801",
            "telephone_number": "336-617-3036",
            "fax_number": "336-617-3036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 DUNBAR ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274013801",
            "telephone_number": "336-617-3036",
            "fax_number": "336-617-3036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAVENLYGATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-11",
        "last_updated": "2008-12-11",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "TARSHA",
        "authorized_official_middle_name": "VIOLET",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-254-3137",
        "authorized_official_credential": "L.P.N."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-041-882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.