Provider Demographics
NPI:1003346263
Name:HEAVENLY SENIOR CARE LLC
Entity Type:Organization
Organization Name:HEAVENLY SENIOR CARE LLC
Other - Org Name:HEAVENLY SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLYCARPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-281-6815
Mailing Address - Street 1:115 SW 9TH TER APT 303
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1744
Mailing Address - Country:US
Mailing Address - Phone:954-281-6815
Mailing Address - Fax:
Practice Address - Street 1:115 SW 9TH TER APT 303
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1744
Practice Address - Country:US
Practice Address - Phone:954-281-6815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care