Provider Demographics
NPI:1467802652
Name:HEAVENLY EARTH HOME HEALTH
Entity Type:Organization
Organization Name:HEAVENLY EARTH HOME HEALTH
Other - Org Name:HEAVENLY EARTH HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/ CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:IBARRA
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:915-355-8480
Mailing Address - Street 1:4761 BEACHAM ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-7358
Mailing Address - Country:US
Mailing Address - Phone:915-355-8480
Mailing Address - Fax:
Practice Address - Street 1:4761 BEACHAM ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-7358
Practice Address - Country:US
Practice Address - Phone:915-355-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN