Provider Demographics
NPI:1376691659
Name:HEAVENLY HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:HEAVENLY HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MC NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-978-8388
Mailing Address - Street 1:102 S. WILSON AVE
Mailing Address - Street 2:STE H
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4960
Mailing Address - Country:US
Mailing Address - Phone:910-978-8388
Mailing Address - Fax:910-892-2987
Practice Address - Street 1:102 S. WILSON AVE
Practice Address - Street 2:STE H
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4960
Practice Address - Country:US
Practice Address - Phone:910-978-8388
Practice Address - Fax:910-892-2987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3627251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health