Provider Demographics
NPI:1619242716
Name:HEAVENLY HANDS CHILDREN'S MEDICAL DAYCARE CENTER
Entity Type:Organization
Organization Name:HEAVENLY HANDS CHILDREN'S MEDICAL DAYCARE CENTER
Other - Org Name:PRESCRIBED PEDIATRIC EXTENDED CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:CARNELL
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-363-3269
Mailing Address - Street 1:8002 WEST AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CASTLE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1865
Mailing Address - Country:US
Mailing Address - Phone:210-560-3938
Mailing Address - Fax:
Practice Address - Street 1:8002 WEST AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CASTLE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78213-1865
Practice Address - Country:US
Practice Address - Phone:210-560-3938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385HR2060X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child