Provider Demographics
NPI:1508635277
Name:BELL, HEAVEN DESTINY ANN
Entity Type:Individual
Prefix:
First Name:HEAVEN
Middle Name:DESTINY ANN
Last Name:BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 S MAIN ST APT 304
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4263
Mailing Address - Country:US
Mailing Address - Phone:330-754-8241
Mailing Address - Fax:
Practice Address - Street 1:1145 S MAIN ST APT 304
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4263
Practice Address - Country:US
Practice Address - Phone:330-754-8241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide