Provider Demographics
NPI:1366044497
Name:HEAVENLY HELPERS HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:HEAVENLY HELPERS HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-305-6567
Mailing Address - Street 1:1055 INGLESIDE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1300
Mailing Address - Country:US
Mailing Address - Phone:667-305-6567
Mailing Address - Fax:
Practice Address - Street 1:1055 INGLESIDE AVE STE 204
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1300
Practice Address - Country:US
Practice Address - Phone:667-305-6567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care