Provider Demographics
NPI:1659979425
Name:HEAVENLY CARE INC
Entity Type:Organization
Organization Name:HEAVENLY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:901-326-4851
Mailing Address - Street 1:117 EVENINGWIND DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-3017
Mailing Address - Country:US
Mailing Address - Phone:901-326-4851
Mailing Address - Fax:
Practice Address - Street 1:117 EVENINGWIND DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-3017
Practice Address - Country:US
Practice Address - Phone:901-326-4851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEAVENLY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-14
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty