Provider Demographics
NPI:1578065827
Name:HEAVENS URGENT CARE LLC
Entity Type:Organization
Organization Name:HEAVENS URGENT CARE LLC
Other - Org Name:HEAVENS URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PERNELL
Authorized Official - Last Name:HEAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-444-1160
Mailing Address - Street 1:105 S DELAWARE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-6512
Mailing Address - Country:US
Mailing Address - Phone:480-646-1001
Mailing Address - Fax:
Practice Address - Street 1:95 S IDAHO RD STE 140
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85119-0006
Practice Address - Country:US
Practice Address - Phone:480-444-1160
Practice Address - Fax:480-935-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care