Provider Demographics
NPI:1376182667
Name:HEAVENLY HOME CARE, LLC
Entity Type:Organization
Organization Name:HEAVENLY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVALCINOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-306-6324
Mailing Address - Street 1:70 BIRCH ALY STE 240202
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1479
Mailing Address - Country:US
Mailing Address - Phone:937-306-6324
Mailing Address - Fax:
Practice Address - Street 1:70 BIRCH ALY STE 240202
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-1479
Practice Address - Country:US
Practice Address - Phone:937-306-6324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care