Provider Demographics
NPI:1497314546
Name:SEVEN HEAVEN HOME CARE LLC
Entity Type:Organization
Organization Name:SEVEN HEAVEN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOELUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-301-5499
Mailing Address - Street 1:554 NW KILPATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-8719
Mailing Address - Country:US
Mailing Address - Phone:772-301-5499
Mailing Address - Fax:
Practice Address - Street 1:554 NW KILPATRICK AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-8719
Practice Address - Country:US
Practice Address - Phone:772-301-5499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility