Provider Demographics
NPI:1275853236
Name:HEAVENLY MEDICAL SUPPLY,LLC
Entity Type:Organization
Organization Name:HEAVENLY MEDICAL SUPPLY,LLC
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER (OWNER)
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:DENICE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:318-283-1210
Mailing Address - Street 1:6349 ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-9749
Mailing Address - Country:US
Mailing Address - Phone:318-283-1210
Mailing Address - Fax:
Practice Address - Street 1:6349 ESTATES DR.
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:NONE
Practice Address - Zip Code:NONE
Practice Address - Country:UM
Practice Address - Phone:318-283-1210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAUDIA HARRIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies