Provider Demographics
NPI:1487830956
Name:HEAVENLY HANDSPCS,LLC
Entity Type:Organization
Organization Name:HEAVENLY HANDSPCS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-279-3184
Mailing Address - Street 1:918 MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-3444
Mailing Address - Country:US
Mailing Address - Phone:225-775-1712
Mailing Address - Fax:225-775-1713
Practice Address - Street 1:918 MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-3444
Practice Address - Country:US
Practice Address - Phone:225-775-1712
Practice Address - Fax:225-775-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA12496251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health