Provider Demographics
NPI:1275256091
Name:HEAVENLY HOSPICE CARE LLC
Entity Type:Organization
Organization Name:HEAVENLY HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:726-262-8410
Mailing Address - Street 1:4115 MEDICAL DR STE 302B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5657
Mailing Address - Country:US
Mailing Address - Phone:726-262-8410
Mailing Address - Fax:726-262-8411
Practice Address - Street 1:4115 MEDICAL DR STE 302B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5657
Practice Address - Country:US
Practice Address - Phone:726-262-8410
Practice Address - Fax:726-262-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based