Provider Demographics
NPI:1588199798
Name:HEAVENLY GRACE HOME CARE LLC
Entity Type:Organization
Organization Name:HEAVENLY GRACE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-490-0109
Mailing Address - Street 1:6847 HIGHWAY 505
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39336-6312
Mailing Address - Country:US
Mailing Address - Phone:601-490-0109
Mailing Address - Fax:
Practice Address - Street 1:6847 HIGHWAY 505
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MS
Practice Address - Zip Code:39336-6312
Practice Address - Country:US
Practice Address - Phone:601-490-0109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care