Heavenly Palace Adult Center, Inc.

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

07186736 Issued in MS

Legal business name

HEAVENLY PALACE ADULT CENTER, INC.

Practice address

1654 Highway 1 N
Greenville, MS 38701-0000

Phone

(662) 378-7262

NPI assigned

Feb 26, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Patrick Jackson

Title

President

Phone

(662) 378-7262

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203984000000",
    "number": "1790954592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1654 HIGHWAY 1 N",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387031943",
            "telephone_number": "662-378-7262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1654 HIGHWAY 1 N",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387010000",
            "telephone_number": "662-378-7262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAVENLY PALACE ADULT CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-26",
        "last_updated": "2008-02-26",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-378-7262",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MS",
            "license": "07186736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07186736",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maroun E Hayek, MD
• Makeisha Haygood, PHARMD
• Kenneth J Hayles, M.D.
• Vanessa Haywood, FNP
• Healing Hearts Center LLC
• Help Limited Liability Company
• Helping Hands Adult Day Center, LLC
• Patricia E Hemphill, NP
• Jessica Stokes Henry, MS CCC-SLP
• John L Herzog Sr., MD

• Preferred Provider Organization in Greenville, MS
• Providers in Greenville, MS by specialty
• Preferred Provider Organization in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 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.