Provider Demographics
NPI:1508369760
Name:HEAVENLY TOUCH HOMECARE LLC
Entity Type:Organization
Organization Name:HEAVENLY TOUCH HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEADRE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-214-9881
Mailing Address - Street 1:2230 NEWPORT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-5436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2230 NEWPORT ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-5436
Practice Address - Country:US
Practice Address - Phone:601-214-9881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysisGroup - Single Specialty
No163WX1500XNursing Service ProvidersRegistered NurseOstomy CareGroup - Single Specialty