Provider Demographics
NPI:1497248298
Name:HEAVENLY'S HOME CARE LLC
Entity Type:Organization
Organization Name:HEAVENLY'S HOME CARE LLC
Other - Org Name:HEAVENLY'S HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:BLACKSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-490-6810
Mailing Address - Street 1:67 BUCK RD STE B53
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1540
Mailing Address - Country:US
Mailing Address - Phone:674-321-5022
Mailing Address - Fax:
Practice Address - Street 1:67 BUCK RD STE B53
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:267-432-1502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care