Provider Demographics
NPI:1093738379
Name:HEAVENLY HOST INC
Entity Type:Organization
Organization Name:HEAVENLY HOST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIJI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-289-3800
Mailing Address - Street 1:2033 MILITARY PKWY
Mailing Address - Street 2:SUITE 305 C
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-3672
Mailing Address - Country:US
Mailing Address - Phone:972-289-3800
Mailing Address - Fax:972-289-3801
Practice Address - Street 1:2033 MILITARY PKWY
Practice Address - Street 2:SUITE 305 C
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3672
Practice Address - Country:US
Practice Address - Phone:972-289-3800
Practice Address - Fax:972-289-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
67-9778Medicare PIN