Provider Demographics
NPI:1558745158
Name:HEAVENLY HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:HEAVENLY HOME HEALTH AGENCY
Other - Org Name:HEAVENLY HOMECARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-978-9405
Mailing Address - Street 1:PO BOX 181523
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-7523
Mailing Address - Country:US
Mailing Address - Phone:216-503-0354
Mailing Address - Fax:
Practice Address - Street 1:3761 WARRENDALE RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44118-2317
Practice Address - Country:US
Practice Address - Phone:216-503-0354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2245834251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health