Provider Demographics
NPI:1316030695
Name:HEAVEN'S ANGELS HEALTH CARE SERVICES INC.
Entity Type:Organization
Organization Name:HEAVEN'S ANGELS HEALTH CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPHIDIEN
Authorized Official - Middle Name:LUCENA
Authorized Official - Last Name:DAWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-679-7682
Mailing Address - Street 1:7366 N LINCOLN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1708
Mailing Address - Country:US
Mailing Address - Phone:847-679-7682
Mailing Address - Fax:847-679-7685
Practice Address - Street 1:7366 N LINCOLN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1708
Practice Address - Country:US
Practice Address - Phone:847-679-7682
Practice Address - Fax:847-679-7685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-01
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010563251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010563OtherSTATE LICENSE