Provider Demographics
NPI:1447411053
Name:HEAVENLY NURSES HOME HEALTH, LLC.
Entity Type:Organization
Organization Name:HEAVENLY NURSES HOME HEALTH, LLC.
Other - Org Name:HEAVENLY NURSES HOME HEALTH, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR,CFO, OWNWER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:956-235-8965
Mailing Address - Street 1:104 DEL CT STE 100
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2248
Mailing Address - Country:US
Mailing Address - Phone:956-726-9700
Mailing Address - Fax:
Practice Address - Street 1:104 DEL COURT SUITE#100
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6417
Practice Address - Country:US
Practice Address - Phone:956-726-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747424Medicare Oscar/Certification