Provider Demographics
NPI:1134506926
Name:HEAVENLY SENT HOME HEALTH CARE
Entity Type:Organization
Organization Name:HEAVENLY SENT HOME HEALTH CARE
Other - Org Name:HEAVENLY SENT HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOKY
Authorized Official - Middle Name:N
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:409-920-4024
Mailing Address - Street 1:1912 N 16TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-3311
Mailing Address - Country:US
Mailing Address - Phone:504-975-0457
Mailing Address - Fax:409-920-4025
Practice Address - Street 1:1912 N 16TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-3311
Practice Address - Country:US
Practice Address - Phone:409-920-4024
Practice Address - Fax:409-920-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid