Provider Demographics
NPI:1598373748
Name:HEAVENLY CARE LLC
Entity Type:Organization
Organization Name:HEAVENLY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BONEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-450-9119
Mailing Address - Street 1:13 BARCLAY PAVILION E
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2161
Mailing Address - Country:US
Mailing Address - Phone:215-450-9119
Mailing Address - Fax:
Practice Address - Street 1:13 BARCLAY PAVILION E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2161
Practice Address - Country:US
Practice Address - Phone:215-450-9119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health