Provider Demographics
NPI:1275304909
Name:HEAVENLY HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:HEAVENLY HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:TASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-324-8506
Mailing Address - Street 1:3414 MOSS ST STE E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-6107
Mailing Address - Country:US
Mailing Address - Phone:337-324-8506
Mailing Address - Fax:337-324-8507
Practice Address - Street 1:3414 MOSS ST STE E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-6107
Practice Address - Country:US
Practice Address - Phone:337-324-8506
Practice Address - Fax:337-324-8507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility