Provider Demographics
NPI:1598427288
Name:HEAVENLY HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:HEAVENLY HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KESABLYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-671-1757
Mailing Address - Street 1:6470 VAN NUYS BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1499
Mailing Address - Country:US
Mailing Address - Phone:818-671-1757
Mailing Address - Fax:818-671-1405
Practice Address - Street 1:6470 VAN NUYS BLVD STE E
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1499
Practice Address - Country:US
Practice Address - Phone:818-671-1757
Practice Address - Fax:818-671-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-10
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health