Provider Demographics
NPI:1376677708
Name:HEAVEN HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:HEAVEN HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARUSYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BGHIYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-517-8743
Mailing Address - Street 1:20944 SHERMAN WAY STE 115
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-3632
Mailing Address - Country:US
Mailing Address - Phone:818-517-8743
Mailing Address - Fax:818-530-1419
Practice Address - Street 1:20944 SHERMAN WAY STE 115
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-3632
Practice Address - Country:US
Practice Address - Phone:818-517-8743
Practice Address - Fax:818-530-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000670251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059017Medicare Oscar/Certification