Provider Demographics
NPI:1073198339
Name:HEAVENLY COMPANION, LLC
Entity Type:Organization
Organization Name:HEAVENLY COMPANION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BRISTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-581-0967
Mailing Address - Street 1:PO BOX 1204
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-1204
Mailing Address - Country:US
Mailing Address - Phone:517-581-0967
Mailing Address - Fax:
Practice Address - Street 1:5158 BLUESTONE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8338
Practice Address - Country:US
Practice Address - Phone:517-581-0967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health