Provider Demographics
NPI:1457488793
Name:HEAVENLY BLESSED HOME CARE
Entity Type:Organization
Organization Name:HEAVENLY BLESSED HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATASHU
Authorized Official - Middle Name:HAMILTON
Authorized Official - Last Name:TUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-353-5595
Mailing Address - Street 1:113 W FIRETOWER RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8414
Mailing Address - Country:US
Mailing Address - Phone:252-353-5595
Mailing Address - Fax:252-353-5509
Practice Address - Street 1:113 W FIRETOWER RD
Practice Address - Street 2:SUITE N
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8414
Practice Address - Country:US
Practice Address - Phone:252-353-5595
Practice Address - Fax:252-353-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3237251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601439Medicaid