Provider Demographics
NPI:1407259575
Name:HEAVENLY CAREGIVER SERVICES, INC.
Entity Type:Organization
Organization Name:HEAVENLY CAREGIVER SERVICES, INC.
Other - Org Name:HEAVENLY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:LATINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-340-0551
Mailing Address - Street 1:13266 POND SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7179
Mailing Address - Country:US
Mailing Address - Phone:512-340-0551
Mailing Address - Fax:512-340-0556
Practice Address - Street 1:13266 POND SPRINGS RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7179
Practice Address - Country:US
Practice Address - Phone:512-340-0551
Practice Address - Fax:512-340-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009538251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health