Provider Demographics
NPI:1477057891
Name:HEAVENLY SENT HOME CARE LLC
Entity Type:Organization
Organization Name:HEAVENLY SENT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:314-665-7199
Mailing Address - Street 1:4102 NEBRASKA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-4492
Mailing Address - Country:US
Mailing Address - Phone:314-665-7199
Mailing Address - Fax:
Practice Address - Street 1:4102 NEBRASKA AVE APT 1
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-4400
Practice Address - Country:US
Practice Address - Phone:314-665-7199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOBLS000875251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health