Provider Demographics
NPI:1366836157
Name:HEAVENLY HANDS HEALTHCARE LLC
Entity Type:Organization
Organization Name:HEAVENLY HANDS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PELICAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-301-5062
Mailing Address - Street 1:900 COMMONWEALTH PL STE 225
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4517
Mailing Address - Country:US
Mailing Address - Phone:757-301-5062
Mailing Address - Fax:757-301-5063
Practice Address - Street 1:900 COMMONWEALTH PL STE 225
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4517
Practice Address - Country:US
Practice Address - Phone:757-301-5062
Practice Address - Fax:757-301-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health