Heavenly Assisted Living, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

HEAVENLY ASSISTED LIVING, INC.

Practice address

401 Orange Ave
Port Orange, FL 32127-4444

Phone

(386) 761-6268

NPI assigned

Aug 11, 2020

Last updated

Aug 24, 2020By 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

Yohannes FissihaNPI 1295346690

Title

Owner

Phone

(386) 767-6268

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Yohannes Fissiha

  • Assisted Living Facility
  • Port Orange, FL
  • NPI 1295346690
  NPD Authorized official

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

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598227200000",
    "number": "1407467806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 ORANGE AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274444",
            "telephone_number": "386-767-6268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 ORANGE AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274444",
            "telephone_number": "386-761-6268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAVENLY ASSISTED LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-11",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A",
        "authorized_official_last_name": "FISSIHA",
        "authorized_official_first_name": "YOHANNES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-767-6268"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; 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.