Provider Demographics
NPI:1477799021
Name:HEAVENLY HOME HEALTH, INC.
Entity Type:Organization
Organization Name:HEAVENLY HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:B
Authorized Official - Last Name:SANTILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-500-9007
Mailing Address - Street 1:805 E BROADWAY STE H
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4539
Mailing Address - Country:US
Mailing Address - Phone:818-500-9007
Mailing Address - Fax:818-500-9052
Practice Address - Street 1:805 E BROADWAY STE H
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4539
Practice Address - Country:US
Practice Address - Phone:818-500-9007
Practice Address - Fax:818-500-9052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-04
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001026251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health