Provider Demographics
NPI:1407386071
Name:HEAVEN SENT HOME HEALTH SYSTEMS
Entity Type:Organization
Organization Name:HEAVEN SENT HOME HEALTH SYSTEMS
Other - Org Name:HEAVEN SENT HOME HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:574-229-8749
Mailing Address - Street 1:2015 W WESTERN AVE STE 132
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46619-3561
Mailing Address - Country:US
Mailing Address - Phone:574-229-8749
Mailing Address - Fax:574-855-1915
Practice Address - Street 1:2015 W WESTERN AVE STE 132
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-3561
Practice Address - Country:US
Practice Address - Phone:574-229-8749
Practice Address - Fax:574-855-1915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14-014155-1163W00000X, 163WC1500X, 163WD0400X, 163WH0200X, 163WI0500X, 163WI0600X, 163WW0000X, 164W00000X, 372600000X, 374U00000X, 376J00000X, 376K00000X
IN28217649A163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No163WI0600XNursing Service ProvidersRegistered NurseInfection ControlGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN14-014155-1OtherINDIANA STATE DEPARTMENT OF HEALTH