Provider Demographics
NPI:1114151925
Name:HEAVENLY DIABETIC SUPPLIES INC.
Entity Type:Organization
Organization Name:HEAVENLY DIABETIC SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HORTENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-779-8697
Mailing Address - Street 1:3700 FREDRICKSBURG RD
Mailing Address - Street 2:SUITE # 230
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-3269
Mailing Address - Country:US
Mailing Address - Phone:210-733-7697
Mailing Address - Fax:210-733-5843
Practice Address - Street 1:3700 FREDRICKSBURG RD
Practice Address - Street 2:SUITE # 230
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3269
Practice Address - Country:US
Practice Address - Phone:210-733-7697
Practice Address - Fax:210-733-5843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies