Provider Demographics
NPI:1437390739
Name:HEAVENLY TOUCH HOME HEALTH CARE, CORP.
Entity Type:Organization
Organization Name:HEAVENLY TOUCH HOME HEALTH CARE, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IBIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:TEJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-406-3648
Mailing Address - Street 1:7212 NW 56TH ST.
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166
Mailing Address - Country:US
Mailing Address - Phone:305-406-3648
Mailing Address - Fax:305-406-3649
Practice Address - Street 1:7212 NW 56TH ST.
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166
Practice Address - Country:US
Practice Address - Phone:305-406-3648
Practice Address - Fax:305-406-3649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006763700Medicaid