Provider Demographics
NPI:1164048963
Name:HEAVEN HEALTH LLC
Entity Type:Organization
Organization Name:HEAVEN HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YANNET
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEGUEZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-451-6464
Mailing Address - Street 1:11303 TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4442
Mailing Address - Country:US
Mailing Address - Phone:561-451-6464
Mailing Address - Fax:
Practice Address - Street 1:1781 NW 123RD AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4383
Practice Address - Country:US
Practice Address - Phone:561-451-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health